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2001-813 TOWN OF QUEENSBURY vrso742 eensb Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE • Permit Number. P20010813 Date Issued: Monday, December 11, 2006 This is to certify that work requested to be done as shown by Permit Number P20010813 has been completed. Tax Map Number. 523400-302-005-0001-085-000-0000 Location: 21 OLD AVIATION Rd Owner. PATRICIA STRAINER Applicant: PATRICIA STRAINER 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 ther--- P 4 property owner of the responsibility for compliance with Site Plan, ay 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. 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: P20010813 Application Number: A20010813 Tax Map No: 523400-302-005-0001-085-000-0000 Permission is hereby granted to: PATRICIA STRAINER For property located at: 21 OLD AVIATION 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: PATRICIA STRAINER Septic Alteration Residential 21 OLD AVIATION Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET OUEENSBURY,NY Plans &Specifications 2001-813 SEPTIC ALTERATION AS PER APPLICATION $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, October 31,2002 (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 the Town of QueTnsbury; Wednesday, October 31,2001 SIGNED BY for the Town of Queensbury. Director of Buil g& de Enforcement Application for Permit-Septic Disposal System Town of Oueensbury 742 Bay Road Oueensburv, NY 12804 (518) 761-8256 1. OWNER INFORMATION: ____.._....___............_.... _. Office Use Location of installation: c)7 61 File Permit No.c>rn Tax Map No. / / Oa w Fee Paid 675 Owner's Name: � � � �C'9'�"�'1 'e r Address: p I 0C/a u-Z t v 4' 2. INSTALLER'S NAME :4_ Inc S S( t'e L- PHONE NCIDCT 3 01 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate #bedroom(s) airebniAt.s)y# o bedrooms with applicable gallons per bedroom to equal Wit; • a A ►4NSBURy fVD CO®� Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older 3 x 150 gal/bdrm = ((C.-O 1980- 1991 x 130 gal/bdrm = 1991 -present x 110 gal/bdrm = Garbage Grinder Installed yes— / no n' Spa or Whirlpool Installed yes / no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) r �, • s.graphy , ature Ground Water Bedrock or Impervious Material /omest3c ter Supply Flat san at�yZay municial Pepth at what depth ': ing am /l,('I feet feet Steep slope clay if well; water supply slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: 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:_ gallon (min. size 1,000 gal) Tile Field: each trench ft. Total System Length: .ft Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: 6. t '`• 1 1-i°Mength and/or size 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. g/(/' l� 0 )&or Signature of responsible person Date Septic Inspection Report Office No. (518)761-8256 Date Inspection reques -ce. -:: Queensbury Building&Code Enforcement Arrive: am/i I-,Part: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: / NAME: Qc \c PE' I NO.: 1 . Y��_ LOCATION: 9,101,c ,�Vir.' INSPECT ON: 1 -' [l9' 1) RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Munici r.1/Well Water Waterline separation di•to,ce ft. Well separation distanc: ft. Other wells: _ _ft. Absorption Field: Total 1-ngt. - ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number _ Size: x Stone Size: Piping Size Type \ W� Building to tank 46.U--4``2N� Tank to Distribution Box OVA\ Distribution Box to Field/Pit Opening Sealed: Y/N/Partial / Location/Separations Foundation to tank ft. Foundation to absorption _ ft. Separation of Pits _ Conforms as per Plot Plan Y N, Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queen_sburyNY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name paT is l R 6T-E al N)F.01 Location 21, ( I___ n�1 nu3 ED Date lZ—(o-t t Permit #7c ( j3 SOIL TYPE: and-,b.oam-Clay- Results of Perc ation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: A/�� ABSORPTION FIELD. Total e'�grth�L <-fN� Length of each tr nch P al Depth of trenches r 7/_�fir' + T Size of stone \ F A\ SEEPAGE PITS: Numbe - \ Size - f' . x ft. Stone size PIPING: E Size Type Bldg. to Tank 4L/c.,; °LI,J I,pa c; Tank to Dist. Box j,�SPP— -4-5- Dist. Box to Field/Pit 'I P t—rc� EjTj Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank to feet Foundation to Absorption feet Separation of Pits fe Conforms as per Plot Plan Y No LOCATION OF SYSTEM ON PROPER : (circl : - - Front Rears ;i •ht Side Middle Fr:'z4/7ddle Rear COMMENTS: ti�� 1�11��v� SYSTEM USE APVROVEf:11 ES NO Arrives • p; i►, Depa• ed: ,;, ri <. Bu ding rector i e \\\a-, j TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name _e C q <'6EaP, EC=R Location 7.1 CAA) f:W t C Date 17 --(p— 1 Permit #2.c` — _3 SOIL TYPE Sand oam-Clay- — Resul is of Percolat o \Test- (if applicable) Rat--Mi\ ute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: To al Length Length of each trenc ' Depth of trenches 1 1 I(�' ICo �{ Size of stone ' SEEPAGE PITS: Numbe Size - f ft. Stone size PIPING: Size Type Bldg. to Tank %1 OCR ai? Tank to Dist. Box ‘+ t! cr Dist. Box to Field/Pi %9C« E E Openings Sealed? No Partial LOCATION/SEPARATIONS: Foundation to Tank \C3 feet Foundation to Absorption 'j feet Separation of Pits fee Conforms as per Plot lan . Yes o LOCATION OF SYSTEM 0 PROPERTY: — (circle one) Front 'ear Right Side Middle on idle Rear COMMENTS: `_ bV\ To I66w SYSTEM USE APPROVED S 0 Arriv- e . d Dep ted AA ( L AiAw:-" llding Ins,e((or TOWN OF QUEENSBURY . BUILDING. &_CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name _ 1 20DEA UX �j t�►i a1E Location 13 OLD ivIlpT1e* RD Date 1z.,4 -61 Permit # `/x)1 — \3 SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test (if applicable) Rate-Minut••/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total eng h Length of each trench Depth of trenches Size of stone 1111 SEEPAGE PITS: Number- V Size - ft. x / ft. Stone size 4 PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Ye. No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorpt on feet Separation of Pits feet Conforms as per Plot Plan . Yes No LOCATION OF SYSTEM ► PROPERTY: . (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: L Ft‘i cT— Cif C�J C►J L TE • ' SYSTEM USE APPROVED: YES NO Arrived: , Depar Bu lding Inspe r Septic Inspection Report .: Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: a Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: 3 PERMIT NO.: 2 / ` i3 LOCATION: 7 ( 00 Ire 1r10)/i�� � INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/Clay Type of Water: Municipal/ Well Water Waterline separation distance ft. Well separation distance ft. 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 Field/ Pit Opening Sealed: Y/ N/ Partial End Cap Inlet/Outlet Pipes&Baffles __,__Y T N Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan ____Y N Engineer Report and As-Built Y_N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use ttus: / Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 . .; . . • ' . .. • - . • . . : • . • . , , . •.: •-•• ..: • •-''' , ..! .. ' -• . • ,kf. ,. • • •. ',u....ii`okiiii, .,•• • • • ... • ' ' ' t:...••• .,;• . 7,4::.q• :4,.. -. , , \ I. - ..!:/. ••• ' • ._. V k'' ••... 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