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2003-983 .i TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number; P20030983 Date Issued: Wednesday,January 16, 2008 This is to certify that work requested to be done as shown by Permit Number P20030983 has been completed. Tax Map Number: 523400-309-017-0001-003-000-0000 Location: 84 EAGAN Rd Owner: MAR.GARET FOOTE Applicant: JOHN&DONNA D`ALONZO This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBUR 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 Building&Code Enforcement 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: P20030983 Application Number: A20030983 Tax Map No: 523400-309-017-0001-003-000-0000 Permission is hereby granted to: JOIN&DONNA D'ALON70 For property located at: 80 EAGAN Rd in the Town of Queensbury,to construct or place 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 Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: JOHN&DONNA D'ALONZO 25 DANFORD Ct Septic Alteration Residential Total Value QUEENSBURY, NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2003-983 SEPTIC SYSTEM AS PER PLOT PLAN SPECIFICATIONS $25,00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,December 02, 2004 (If a longer period is required,an application far an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the 1 wn of )Z�v u December 02, 2003 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement AppXicatioa for Permit Septle Dlsposa i Town of Queensbury 742 Bay Boad Queensbury,NY 1280'11 ,j8) 76182.60 1. OWNER INFORMATION: � r[rLr�i 1"" P (� Office Use Location of installat3an. 'j� , ()�t�� Tax Map No. l / �,/ ( 1D Owner's Name: QN `A C.a�� t„,Fe�Pat..� D �.....�as ......... Address: t--S, 2)d4/LI/:0, 2bT ' 2. INSTALLER'S NAM>1 P/t(/g4-Z PHONE NO. -7192, ' '?c)J- 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply#of bedrooms with applicable gallonsperbedroom to equal.total dailyflow) Year of House; Na of Bedrooms x Conroutation = Total Daily Flow 1980 or older x 1 SO gal/bdrm = �� 1980- 1991 x 130 gal/bdtm = 1991-present x 110 gal/bdrm Garbage Grinder Installed yes` / no Spa or Hot Tub'Installed yes„ / no 4. PARCEL n4FORMA.TION: (circle applicable information&indicate measurements) d c1corltnuerviousm, u ] Ft and at what depth at what depth rriun olling _feet ______feet w Steep slope clay 'if well;water supply -%slope other from any sepric-system depth: absorption is ft. Percolation Test:. (To be completed by licensed professional engineer or architect) other Rate: minute per inch S. PROPOSED SYSTEM; For New Construetign: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Plauning Board approved subdivision). Add 250 gallons to the size of the septic tank and leach yield for each Oarbage Czrinder,Spa or Vn&lpooI Tub. Septic Tank: 1 dyi, gallon (min. size 1,000 gal,) 5AJ F7 c.7?ZAUIf-f Tile Field: each trench Total System Longth. Seepage Pit(s)s number of //A, size of each: ft, by ft. Size gf Stonc to be.used.: # l depth or thickness feet lBed System size: x r Alternative System: length and/or size 6. HOLD13ST{3 TANK SYSTEM:. (if required) Number of tanks: I Size of each: gallons /TOTAL-Capacity: gallons Note: AIarrn System and associated electrical work must be inspected by a Town approved electrical inspeatiori agency. 7. SIGNATURE &INFOR LkTION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section.136-29 of the 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 makt a material.fact or circumstance 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 these and all requireme the Town of Q bury Sanitary Sewage Disposal Ordinance. L. S z4b ,04'? ature of respo sible person Date roa,/rao 18 XVd cc:sx 31`1,1, soot/Yo/co Y Septic Inspection Repay "Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/p • Depart: am/pm 44 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: - NAME: -� PERMIT NO.: �- .��.�_ .� LOCATION: INSPECT ON: RECHECK Comments and/or diagram Soil Type: Sand Loam Cla T, ype of Water: Municipal/Well Water Waterline separation distance fL Well separation distance rt• Other wells: • Absor tion Field: Total'len Length of each trench ft• Depth of trenches • Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Openip Sealed: Y NJ Partial End Ca Inlet/Outlet Pipes&Baffles Y N Location SepArations Foundation to tank •_ Foundation to absorption ft• Separation of Pits ft• Conforms as r Plot Plan Y N En ineer Re Dort and As-Built Location of-System on Property: Front Rear Left Side Right Side Middle Front iddle Rear S m U e s• Approved Partial.Approved and needs to be_ 're-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 4pVt is Inspection eport . Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pal D part: 'am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: , PERMIT NO.: (�)-00 - 11 V LOCATION: INSPECT ON: RECHECK. Comments and/or diagram Soil Type: and/Loam/Cla Type of WE . unicipal/ ell Wat,r Waterline separation distance ft. Well separation distance ft. Other,wells: ft. Absorption Field: Total length ft. Len h of each trench ft. Depth of trenches ft. Size of Stone .- See a e Pits: Number Size: x Stone Size: Piping S'Zf A Type. Building to tank . Tank to Distribute n Box t i L% V Distribution Box o ield/Pit , Opening Sealed:(Yj NI Partial Location/Se arati Foundation to tank 5 -. Foundation to abso tion Separation of Pits Conforms as per Plot Plan Y N 'Location of Sy st- on Property: Front ea Left Side Right Side Middle Front Middle Rear System Use i- rtial s: proved a Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FQRMS\Septic Inspection Report.doo January 28,2003 a. g Septic Inspection Report Office No. (518)761-8256 Dater inspection request received: Queensbury Building&Code Enforcement Arrive: am/p part: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initlals: i NAME: PERMIT NO.: LOCATION: INSPECT ON: :RECHECK: Comments and/or diagram Soil Type: •Sand loam/ Clay = Type of Water: Municipal/Well Water Waterline se ration distance • Will-separation distance • Other wells: ft. Absorption 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 Feld Pit O""nin Sealed: Y N Partial End Ca Inlet/Outlet Pipes&Baffles Y N Location/Separations Foundation to tank • 4 � Foundation to absor flan • ' Jrti Separationof Pits fk. Conforms as r Plot Plan Y. N �u (;U �tldl-)' i r Report and As-Built Y N C�u - En nee Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear 5&stem Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 " 93 BUILDING REVIEWED DATE 2 a 4 i yJ^y J i have seen or observed, or heivev4 I saw evidence of, all olbJecfs st#ch as 'houses, ;4'ri1s, trees, fences, arc., s ' rt nn Olts do ' l ( -also pe .��.,y '}.1¢ I h;-air J , ii JiJ. �. r�t S 1..,i,l iL�� .�. 'i �. liit i..:riJ N Sty tit.l ::teas �)eat toilh n; die SIG A-TURE Ai •