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2001-525 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: P20010525 Date Issued: Wednesday, July 18, 2001 This is to certify that work requested to be done as shown by Permit Number P20010525 has been completed. Tax Map Number: 523400-301-008-0001-025-000-0000 Location: 2 MANOR Dr Owner: J. BUCKLEY BRYAN JR Applicant: J. BUCKLEY BRYAN JR This structure may be occupied as a: By Order of Town Board Septic Alteration Commercial TOWN OF QUEENSBURY Director of Building&Code Enforcement %T TOWN OF QUEENSBURY ` 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010525 Application Number: A20010525 Tax Map No: 523400-301-008-0001-025-000-0000 1 Permission is hereby granted to: J. BUCKLEY BRYAN JR For property located at: 2 MANOR Dr 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: J. BUCKLEY BRYAN JR Septic Alteration Commercial C/O QUEENSBURY ARMS OFFICE Total Value 70 MANOR Dr QUEENSBURY,NY 12804 I Contractor or Builder's Name/ Address Electrical Inspection Agency OUEENSBURY SEWER JAY SWEET Plans &Specifications 2001-525 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS i $35.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,July 17,2002 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at th To f Q/ns ury f1 sd,__ ,July 17,2001 SIGNED BY 17 t� for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 . 1. OWNER INFORMATION: , 1 Office Use - Location of installation: -`b ' 17) y,9__�; J_Jz_ File Permit No.C^% v `�`��1 Tax Map No. / / b c� Fee Paid L Owner's Name: a ii_e_k le_v 61' 1&: Address: ‘ ,LC---- wall 4-- ---o,t't v---e--:--- 1 > — 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dw m , indicate#bedroom(s) and multiply# of • bedrooms with applicabl lops per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily FIBEC• E[�/E® 1980 or older /fi x 150 gal/bdrm = _. J UL 1 6 20 01 1991 —present x 110 gal/bdrm = 1980— 1991 [ x 130 gal/bdrm = CNN OF QUEENSBURY BUILDING AND CODE Garbage Grinder Installed yes— / no y. Spa or Whirlpool Installed yes / no `)' • 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply • Flat scrn at what depth at what depth ' municrpa Rolling loam feet feet well Steep slope • clay if well; water supply _%slope other, _ _ _ from any septic-system - depth:• absorption is ft. other Percolation Test: (7'o be completed by licensed professional engineer or architect) Rate: C minute per inch ' 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. • Septic Tank: 7c.5 c gallon (min. size 1,000 gal) Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s): number of size of'each: fi. by ft. Size of Stone to be used: # / depth or thickness feet • Bed System Size: x • Alternative System:• Av c • length and/or size /' 3 a. 6. HOLDING TANK SYSTEM: (if required) • Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION 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 make 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 requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Vr7 J /responsible Siprat6f erson Date TOWN OF QUEENSBURY . BUILDING &_CODE ENFORCEMENT 742 Bay Road Queensbury NY12804 • (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name t3RiP6 CQJEE4',OR`l Af'_r'1 Location k, E-1M 4An)pF DENC Date 7—u l —o 1 Permit # 7_001^-5 SOIL TYPE: Sand-Loam-Clay- Results of Percolati .n Test- (if applicable) 'ate Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: To al Length Length of each t enc Depth of trenches Size of stone SEEPAGE PIT' : Nurser- Size - t. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank. to Dist. Box Dist. Box to Field/'it Openings Sealed? es No Partial LOCATION/SEPARATIONS Foundation to Tank feet Foundation to Absorption feet Separation of Pits _ feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM 0 PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: r'Lfi R Po EfJ ( SYSTEM USE APPROVED: YE NO Arrived: Depart Bu ding Insp or 1111111 TOWN OF QUEENSBURY . BUILDING $_CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 • (518)761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name R Pi�� ( l�)‘3FR)�1 J Location CO V kt-A ik-160P, 1--)R"-F Date -7-17—o) Permit # 7c>01- 5Z5 SOIL TYPE* Sa m-Clay- Results of Percolation Test- (if applicable) Rat • 'nute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: otal ength 4-' Length of each tre ch aZ� Depth of trenches a Size of stone -cc z 1, SEEPAGE PITS: Num, Size - ft. ft. Stone size PIPING: Size Type Bldg. to Tank c-J,, col'\.a0� Tank to Dist. Box 4" 40 Dist. Box to Field/pit �cto " . Openings Sealed? es No Partial LOCATION/SEPARATIONS: Foundation to Tank 541 feet Foundation to Absorption 7 N feet Separation of Pits _ et Conforms as per Plot Pl :n Ye o LOCATION OF SYSTEM ON P'OP . (circle one) Front - Rear - - L ide - ' 'ght Side Middle Fron - Middle Re. COMMENTS: E > � 1‘JAC.---- ��L ---�� SYSTEM USE APPROVED: YES NO Arrive Depa- ed: Tri / Building Inspector COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL % Permit No. Cert. No /¢2 1 Cut-in Card No. 1 Owner �'"�/..�� Location q-vo DePa-at , Installation Consisting of..t} Pa Co&772eLG f%) Installed By ,l1 SAtti L4/61—z Lic.No. The conditions following governed the issuance of this certificate,and any certificate previously issued is cancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon tit( introduction of additional equipment or alterations,application shall be promptly made for inspection. Inspectors of this Company shall have the privilege of making '• pections at any time, and,if it: rules are violated,the Company shall have the right to ev%ke thi r cat Date ` -/7-6( INSPECTOR 91V0 I. A:9 03M3IA I ,.. r v.+ „d.,,ks. sz..,„:„,,.r-,::_,..i_,..;; 'ix, ) --'1-1 .‘"‘11\11,01 4. 14- A . r . , - . . -.. 3 .. :.,.- 05' .. . _________, , . :., ,,, ,. . • , . . , . .. . :,,, ,) • , . .4^' .' , Ltk . . . , ., CIS Le.,,, ;TN---a.AKOL.-...) '‹.7"-"p t4 vyx... f ' r { t '',-r--71-- 340�aNb 0� -� 0 _ •ANn8SN33no (3,i 1Al . NM01 loot 9 17nr ---'----: ' . . . ,Sr___9- 1 cic..•= ' "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., shown on this document. I also represent that I have - per ally measured the d' ances set f th on the diagram. • ''' -' SS9 ' — S v'A 7gn 1'13---q SI NATURE. DATE .4. :: .4 ,