2003-492 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NTY 12804-5902 (518)761.8201
Community Development-Building&Codes (518)761-8256
CERT. IFICATE
OF COMPLIANCE
Permit Number, P20030492 Date Issued: Monday,May 08, 2006
This is to certify that work requested,to be done as shown by Permit Number P20030492
has been completed.
Tax Map Number: 523400-252-000-0001-075-004-0000
Location: 2999 STATE ROUTE 9L
Owner: DUNHAMS BAY REALTY ASSOCIATES,LLC
Applicant: DUNHAMS BAY CORP
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, `
Variance,or other issues and conditions as a result of approvals by the Director of Co �o%
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20030492- Application Number: A20030492
Tax Map No: 523400-252-000-0001-075-004-0000
Permission is hereby granted to: DUNHAMS BAY CORP
For property located at: 2999 STATE ROUTE 9L
1
in the Town of Queensbury,to construct or'plade ' * , "'J" 41
,
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Build
ing Codes and the Queensbury Zoning
Ordinance,
T"e of Construction Value
Owner Address: DUNHAMS BAY CORP - Septic Alteration Residential
2999 STATE ROUTE 9L Total Value
LAKE GEORGE,NY 12845
Contractor or Builder's Name J Address' 1°'Electrical Inspection Agency
Plans&Specifications
C,
A2003-492
SEPTIC ALTERATION TO RESIDENCE AS PER PLOT PLAN SPECIFICATIONS
ii
$25.00 PERMIT FEE PAID-THIS PERMIT E.&FI.Khb: Thursday,July 01,2004
(If a longer period is required,an application for an extension miss bd made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at th* oww f QuIelsb ry; July 01,2003
SIGNED BY for the Town of,Queens.bury.
V
Director of Building&Code Enforcement
y.. Application for Permit.—Septic Disposal System
Riwn U/fQte(v;sbtNy�7•l213oyRuud Ortt'G'/rSlTtrt.V,N}' 12i30! (:5/S) 761-82.56
I. OWNER INFORMATION:
Location of installation: 2999 State Rt. 9L 0ft3ce Use i
File Permit No. �3
Tax Map No. 10 f 1 ! 17.1
Owner's Name:_Griff Parr
Fcc Paid
_................................_...............................
.........
Address: 2999 State Rt. 9L
2. INSTALLER'S NAME : To be determined. PHONE NO.
3. RESIDENCE INFORMATION: (circleyecrr of dwelling, indicate If bedroom(y)and multiply!F of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No -of Bedrooms x Conmutation Total Dail Flow
1980 or older• x 150 gal/bdrm =
1980-- 1991 x 130 gal/bdrin =
1991 —present 3 x l 10 gal/bdrni = 130 "
Garbage Grinder Installed yes— / no X
Spa or Whirlpbol Installed yes / no X
4. PARCEL INFORMATION: (circle applicable information &.indicate measurements)
To,3-QZI" ly StZi(ha trp 4,r_pt�nd Wator� Bedractc ater�i-1t _Dotr�gstic Wate��Stijthly
Mat scrric! -ot svlrut clet,1111 cr!sshat cicptlr rnruriciperl
lWling locrtn feet feet well
Steep slope clay if well; tivcrter supply
8-I0%slope other See See Plans
' �ro» any septic-system
depth: Plans ,
absuiption is,160± it-
other
Percolation Test: (To be cotiipleted by licensed prcrfessldnal engineer or architect)Rate: nrilittle per inch
5, PROPOSED SYSTEM: For New Coustruction: All individual sewage disposal systems inus be designed by a liccissed
professional engineer or iirchitect(unless installed in a Planning 13oard approved subdivision). Add 250 gallons to Ille size
OF(lie septic tank and leach field for each Garbage Grinder.Spa or Whirlpool Tub.
Septic Tan k: .1000 gallon(min. "size 1,000 gal)
Tile Field: each trench P Tans .f. Total System Length:
Seepage Pit(s): nrurrber of N(A size vfeaclr: ft. by
Sizo of Stono to bo used: fl N/A / depth or ilackne.ss feet ..
Bed System Size: N/A x
Alternative System: N/A length andlar size
6. HOLDING TANK SYSTEM: (if required) N/A
Number of tanks: 1 Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work lutist be i3i spected_bys�_TosvcLapproved
o e�ctrica ins on agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) .
For your protection, please note that pursuant to Section 136-29 of tho Code of the Town
of Queensbury,any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or failure to make a-material fact or
circuinstance known by or on behalf of an applicant, shall be void.
I have read,the regulations with respect to this application and agree to abide by ilsese and all
requirements,oftlie Towi Queensbury Sanitary Sewage Disposal Ordinance.
�gn re o esponsilile person Date
LETTER OF TRANSMITTAL ':
Professional Engineering
12 East Washington Street
Glens Fa||e' NY 12801 o»^e
TEL 518-792-2907 ATTENTION
FAX 518-798-1864
�
vvs/xREGEmm|mGYDu )QAttaoheu [] Under separate cover via —the following items:
[]Shop drawings []Printa []p|enn El Samples []Specifications
[]Copy ofletter []Change order []
COPIES DATE NO DESCRIPTION
-
. \
THESE ARE TRANSMITTED as checked below:
* For approval [] Approved as submitted [] Resubmit —copies for approval
O For your use [] Approved ssnoted [] Submit ______-copies for distribution
O As requested O Returned for corrections [] Return —corrected prints
�
O For review and comment O
O FORBIDS DUE O PRINTS RETURNED AFTER LOAN T0US
REMARKS
COPY T
SIGNIED—
x,encl,aures are not manoted.kivdivnourresmtonce.
Septic Inspection Report
Office No.(518)761-8256 Date Ins ectio equest rece' ed:
Queensbury Building&Code Enforcement Arrive: a p rt: am/pin
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initial •
'
NAME: V l
�� � �~ �) PERMIT NO.:
LOCATION: — INSPECT ON: c ��
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal t Well Water
Waterline separation distance _ft.
Well separation distance ft.
Other wells: ft.
AbsoEption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field 1 Pit
Opening Sealed: Y/N1 Partial
End Caps
Location/Separations
Foundation to tank ft. r
Foundation to absorption
Separation of Pits ft.
Conforms_as_ner Plot Plan _ N
n ineer Report and A -Built Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Fro Middle Rear
System Use St teas:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 116105
COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC.
Main Office 176 Roe Rua Road - Manheim, PA 1754
MUNICIPAL CERTIFICATE of ELECTRICAL APPROVAL
Permit No/ N,O � 0 Cut-in and Not•Rriiirruuiiii►iiri/rii►ii1Rr!•R!
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Installation ConsistingY RNifiiHi ii •if fifSi.. ..... rf}MHw} ui•fi if/i i •FiflR fli !!•f1i11irifiuirrrNrHe!•R••rl
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Rriuf iifuR►►•!R►f N!f NliiiiiiliN►rrrrRylilYit!lflR►ff#N►!R#RRiti#if►li►!l►►ff r•iii►/•i•i•ff/!•fait/R!•••ui•i•R•H//riN►qrN►f Rf}•Nr•••f••1!•i1Y••f•f•N•i/fff•►rrrfirrf►r
rffia!lily►l►f!lMrfaafi•!#H#aRiiaifiRN•ai►•IalfflifiaafiaiN►•liff►lf aiffatalaaN#fii►HRafllff►H#ry fiyl•Nipr!►1liiHlliaflflil!}}iaaaiaiaff►►lflil►Rif
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Byt 1 /1 1' �}nstalled •ri ►UTiiMi�/�f i#nR• i�• i�r(H!R•iui •i .� ir"/i•�ii77i filiirffii+++`i No. i/iiNtii►irffiirrf!!llfiuifr••#r••i••ir•ifni/i
The conditions following governed the issuance of this certificate, and any certificate previously issued i;
cancelled,
This certificate only covers the electrical equipment and installation conditions as of date, Upon th(
introduction of additional equipment or alterations, application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making inspections at any time, and if it,;
rules are violated, the Company shall have the right to revoke this certificate,
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f+atirtiii• !1 1•►fi !flltff►li7fR#}►!NR!}•#ata INSPECTOR fffr !lift ♦!fl fiN off f i i►fi iii ifillf►flit!!►►li!#►ilfiHi►fiitiil►►i
MAmhAr K A..LATI
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request r eived:
Queensbury Building&Code Enforcement Arrive: e rt: am/pm
r's Initia .742 Bay Rd.,Queensbury,NY 12804 Inspector's
NAME: P IT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil T San D am 1 Cla
.e Municipal&ell Wat%,Waterline separation distance
Well separation distance ft.--k-
Other ivells: V,D,V-i��- ft,
Absorption Field: Total length )q ft.
Length of each trench
Depth of trenches
Size of Stone tx XARM-t�
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Et .r �ti � \MN
...r0istribution Box tb ield/Pit 6UA a, w-)
Location/Separations
Foundation to tank r)
Foundation to kb<0+T'-w ft.
Separation of Pits ft. T \ $J j,-\L (.:D
Conforms as per Plot Plan Y N -9-2,I-A,
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Status:
givroved.
/Partial Approved and needs to be re-inspected,please call the'Building&Codes Office
Disapproved
L:\SucHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
Septic Inspection Report
Office No.(518)761-8256 Date Inspection re -ec iv .
Queensbury Building&Code Enforcement Arrive: pm 0-0 an �
742 Bay Rd., Queensbury,NY 12804 Inspector's Initia
NAME: IT NO.: C) c..
LOCATION: SPECT ON: V4t
RECHECK: C "I �/
Comments a /or diva'ram
Soil Type: Sand l Loam 1 Clay
Type of Water: Municipal/Well Water
Waterline se aration distance ft. o�='�C. �oJ 6QRC-
Well separation distance ft, b fl! oexz o1��
Other,wells: ft. E "Tfl�
Absorption Field: Total length
Length of each trench
Depth of trenches ft. c���'1p��i
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
17
Piping Size Type N:
Building to tank Vie
Tank to «
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as_per Plot Plan Y N
Location of System on Prop/Akty:
Front Rear Left Side Right Side
Middle Front Mi
ddle Rear
System Use,Status:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
LASueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003