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2000-420 TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: 2000420 Date Issued; Tuesday, September 26, 2000 This is to certify that work requested to be done as shown by Permit Number 2000420 has been completed. ��yy Tax Map Number; 523400-048-000-0008-003-0 -0000 Location. 30 SURREY FIELD Dr Owner: THE MICHAELS GROUP LLC This structure may be occupied as a: Single Family Dwelling By Order of Town Board TOWN OF QUEENSBURY Director of o of BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury, NY 12804 Q 489 , 1 5 — )� 314 `3 County of Warren .(^5�18) 761-8256 - Building Permit No. ca[ Permission is hereby granted tol ITS r� Owner of property located at LOT in the Town of Qumnsbury, to construct or place a at the above Location in accordance to application together with plot plans and other information hea to filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordmancc. &12:5�JW A4 Contractor or Builder's Name: Contractor or Builder's Addre t i nLi Electrical Inspection Agency: Type of Construction: uq PlansQ and ,}Specifications- Ptah t,�►+15� +�L'' Proposed Use: JvA S PERMIT FEE PAID — THIS PERMIT EXPIRES AO- a3 (Lf a longer period is required, an app ication for an extension must be made to the Code Enforcement Officer of the Town of Queensbury before the expirati date.) Dated at the Tovmof Queensbury this Qb Day of SIGNED BY ,�( ^1 �_ for the Town of Queensbury Code Enforcement Officer Building Permit Application Town Of QUeelllSbUry - DrIg. of Community Develap pent, 742 Lkry Road, Queenshut,v, NY 12804 1761-82561 BUILDING ec . CODE ENrORCEMIENT Requirements prior to 'issuance A permit must be obtained before of this permit. PERMIT l7Lr N©. beginning construction. No inspections PERMIT FCE PAID will be made untl! applicant has received Zonhig Board Action: a VALID BUILDING PERmrr, An Arch 1 Usc RGCRLrtTIC7N 1 CG I* applicants` spaces on this application MUST be completed aed• the signature Q Pkinning Board Action R c VIEWED B of the applicant- must appear on the SPR I Subdivision 1 Other Y.4 IF BniLtt�rtg t,.eptavnr t plictttion form., t� Recreation Fee Payment t: T1: t Applicant: x2t`5 4 'y� t _ Owner: "f LIE. Address: . tSTn e2 . i' 1 `, 4,�i � r2[5?C� Address: Plione / ( � _� - 1 Phone # ( ) Property Location. So --__ Subdivision Narr Tax Map Number _ t C/ 1. 1913 Section 111r>ck I nt NATURE OF PROPOSED WORK : ESTIMATED MARKETv1•1 LtJE QF T liE residence New Building *e ideace commercial CONSTRUCTION . $ II7Y r .� C� ,/ Addition to Building * residence / commercial OCCUPANCY INFORMATION : Alteration to Building : Primary Building - residence / commercial �� Single Family Dwelling Residence / commercial Two Family Dwelling no change to exterior size Family DwellYncf- - = - Office Other Work ( describe below ) Mercantile Manufacturing Other l GROSS AREA OF PROPOSED STRUCTURE : / , 1st Floor . . . . . . . 5� . ' s If ADDITION , what: will use 2nd ,Floor . . . . . . . q of new addition bed . s q . f t .,"q/ �, Other Floors . . . . . sq . ft . { not unfinished cellar or basemen ,�,r ACCESSORY BUILDINGS 1T� C' Detached Garage 1 , 2Lar TOTAL FLOOR AREA : JSl SQ . F'T . �� Attached Garage l , Private Storage Building SIZE OF NEW STRUCTURE : Commercial Storage Building LJS_ FEET x 35 FEET" Other Foundation Type : : CK, 'Czsr� Will any second- hand or + tngraded Number of Stories . lumber be used ? if so , for what. ? ( habitable space only ) Height ( ggrade to ridge ) : feet TYPE OF HEATING SYSTEM : Number of fireplaces and / or woo stove { circle all which plies ) to be installed : aM Electric f © il / as / Wood Forced Hot Air / Baseboard / Other Person rei . nsible fo crvislon a t work as regards to building codes i 4 alA WoNrc% eh s+� v N A dressm Phone Builder : b lk 15 Mason : 1 l c' Electrician : AAAke Lncis'z"L D,ECLARA7709• Please sign below af?e' you have carefully read the statenserzt, To the best of my knowledge the statements contained in this application, together with the plans and specifications submitted, are a true and complete statement of all proposed work to be done on the described premises and that all provisions of the Building Code, the Zoning Ordinance and all other laws pertaining to the proposed work skull be complied with, whether specified or noted , and tllat stick work is authorized by the owner. Further, it is understood that I/we shall submit prior to a Certificate of Occupancy''or Certificate of Compliance being issuer[, an AS BUILT PLOT PLAN by a licensed stu-vey • drawn to s ale, showing actu l lac tion of project an premises. Signature: (ow er, owner's agent, architect, contractor) Applicaition for Permit — Septic Disposal System 7' Aivn of Qtteenshtuy 742 Ray Road Qxreensbirrv. NY 12804 (.518) 761-ty2156 1 . OWNER INFORMATION : .... .... ..... ... ............ Office UW Location of installation: File Permit Nt'csJp ± 'z G -' Tax Map No. Owner's Name: Ti LAy. 1 Fee Paid _I I d d d ............. ...... .. .......................... Address: t 2. INSTALLER'S NAME CDC 'ems ] fir PHONE NO. 3 . RESIDENCE INFORMATION: (circle year of dwelling, indicate 0 bedroom(v) and multiply fl of• bedrooms with applicable gallons per bedroom to equal total dailuflow) Year of House: No of Bedrooms x . ..gomputat on — _Tottnl Daily Flow 1980 or older x I50 gaUbdrin = 1980 — 1991 x 130 gal/bdrin 1991 — present x 110 gal/bdrm Garbage Grinder Installed yes / no _ Spa or Whirlpool Installed yes 1 no �C 4 . PARCEL INFORMATION: (circle applicablo information & indicate mcasurements) T a rra h oil IN re GroundWat r Bedrock r bri ervious Material Domestic Water Supply Mal sa►t at what depth at what depth trrrslwvipal (dolling loam 3n ftet _feet ,r- sleep slope clay i}'well; sVater supply �`% slope other ./i- om rrtiv septic-.system depth: absorpuiutr is othar Percolation Test: {l ft be crorrrplclecl by licctived IJPttfC.S'.5'1otTCt1 er7fylneG'r fir arGlrit[G'r) - Rate: minfac Per inch 5 . PROPOSED SYSTEM: For IVery Construction: All individual sewage disposal systcins must be designed by a licensed professional engineer or architect (unless inslallcd in a Planidug Board approved subdivision). Add 250 gallons to the sire of tlxe septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: OCX� gallon (min. size 1. 000 gal.) Tile Field : each trench 1 ft. Total System Length : V.09 _f1. Seepage Pit(s): number of size ufeach. �ft. by f1. Size of Stone to be used: I1 �—,_ / clupth or thtektvess — —.feet Bed System Size: x Alternative System: , length and/or size 6. HOLDING TANK SYSTEM: (if required) Number oftanks : No&& / Size of each: gallons / TOTAL Capacity: gallons Norte: Alarm System and associated electrical work muu be inspected by a Town approved electrical inspection agency. 7. SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please read) For your Protection, }Tease 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 nxake 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. Sigriature of responsible person Date I irr � 1 ;lrslt,tl 'ti i)lficv f'OWil o! Q7 Icctt5lturv. 742 13as Ro'I 1 , [lsiccnsl 8) 7oI -S2o Application for Fuel Burning Appliances & Chimneys applicable to solid fuel & vented gas appliances k +tom I Pet-wit No . --" --_.----- s lf7flli['tfllflrl Is /IeIebI rnctrie Ill the 1311ildino & C'rlcie-� (aili{ -it• pIr' thc' i.ti-eu 'If rc-L< I?I c1 13r1ilclrr7r; r1r1tl tJV('' Permit mit Plirsit(tttt 10 file New York .State Fire Yr ovewirlrl Lind 1311iltlmg ( Odd. 7,he upplu artt o1. o101er• tigrtees to compiv with ttll applicable ;flit ,!', oreltr1Cl11ces. r'z 7 Ideffiollti. 4-Wel erll c olrelitiorr,a' that ore pa1•t (ll' these retluircnrettrs and alsrl will allow ttll in.speclor.s to elite)- 10t>.} 10 perJurrlr rc'gmred itrspection,s. NOTE to applicant : Dough- in and Final Inspections are required . � Applicant Information Fuel Burning Appliance Information ,y �r S� /` (i trcle ap{3t•c}l�a�iazz ss�ctrds) ?'Fame : ��_ # L l � °�T ,J stogye+ wood coal Pellet gas ddr4ss: Fii—epl ice, factorv-i>tlilt : 11'•ood lvrts ) i Fireplace. 111asont-y: wood g_crs .Fttrnacc; Wood ga�� oil f Phone: if non-ttiasonary applicance, please provide Owner: � Nr1aliufac( urel- Name: i7 Address: Model Number: l Chimney Information Phone : {circle al>propt'iate ss cards) Masonry Block hrlck stone fV Flue the :sty size_ inches Exact Address :,, �l)f'f t ofconstnuctiorr or Prrstaliatialr I'aC[Qr'V-Built Mai itt fact ttt"er nairle: Model NU1171 CV: , ;!tote Listed B : h)t. n tber: Constrt.tction / Installation tntrst F rota orttr to NYS Fire Prevention & Bleilelirrg Indicate (cif-cle) chi ,1111ey mate:'ial : € Code, Coristilt available Town of Queens!>ioy Handouts regarding required inspecriolis. Double wo// Tr-4jpls rtxrll hisrelc+ttrl 1 prr(Oct ven11,11 l Clr ilrrl3 L'l' l�N3c'r' I ' yrPAW UwtX•.• rCs]GIlLr'Ya U.f $azae,Laaan[Aia XauxV3s, W-deVMV X* <>-Jt . k -- ' ;`ir c' :Strrrslrtrl Code # S C rlllrcr r± 4 l2c>firrlclt'rli'C'C'f 1' "Ll 11'ClIII ,�' ttrlcl!'css: t ) 7.1 3389 II 9tr) f'rr£llic .Strfc tv _..-- -f 333 2655 1 2 30) Alirlcrr' .Stile.~ j r l ' hite (Appfica»t) Green ( Fire M:trslial ) S'ellolx Bld6. D pr, } Pink b Cioict.°nroci (C�aslije, S Dclit. ) � i i I i TOWN OF QUEENSBURY BUILDING & Coot E"ORCEMENT 7 2 SAY ROAD RUEENSBURY NY 12804 (518) 761-8256 ARRIVE : DEPART: PUPAL INSPRC'.CION RL'1'ORT - RE$IITBNTIAL- . DATE INSPECTION REQU[3ST RMCEIVED : NAME LOCATION DATE Znr J PERMIT "' TYPE OF STRUCTURE FOOTINGS FOUNDATION ROUGH PLUiNajlfG BACKFILL FRAMINGFINAL, ELECTRICAL; SEPTIC INSULATION _.�._ WOODSTOVE OR FIREPLACE 'N 6 Cf C I E T s VEN I H � �,I UL49ING V I S i E O s s 1 L&LIEP* VALVES_._ BEAT U C OT w T I IO I V CY s ems : J T pp H N W I H TH QORS S E P E OTHER FLOG C S A R CL A CE I INGS i QKE D T O S FLUMAINa-rIXTUASS FOVND H U N GAR-AGE FI 00FI G MOR CIO R EINAL ECTR CA E FLAN,�VAR IANCE,itE4 FINALS RVEY P T, ..�..._.�._�.� PLAN J� QK TO iSSUP; C/O 47R /r^ J FIRE MARSHAL TOWN OF QUEENSBURY� QUEENSBURY. NY 12804 )7Q (518) 761-8205 FIRE MARSHAL INSPECTION REPORT REQUEST RECEIVED NAME / y LOCATION PERMIT # SCHEDULE fNSPECTfON AM PM APPROVED EXITS N/A YES NO AISLE WIDTHS EXIT SIGNS �~ _ EMERGENCY LIGHTING ` i FIRE EXTINGUISHERS + FIRE ALARM SYSTEM FIRE SPRINKLER SYSTEM 3 FIRE SUPPRESSION SYSTE HOOD INSTALLATION INTERIOR FINISHES i j STORAGE: _ CLEARANCE TO SPRINKL S CLEARANCE TO HEATING S i REQUIRED SIGNAGE CHI D STOVE IREPLACE MASONRY FACTORY 8t T, ] F7 UGHJN FINAL REMARKS: ❑ OK TO THIS DATE nrsasuv,rua INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS , .st. ■ UREAU OF ELECTRICITY ' 40 FULTON STREET, NEW YORK, NY 140S8 1 , + .bate k.3 tYs1Ik / PFallo a 0o THIS CERTIFINS THAT pi - till A L y ;r rk 4 43 only the elveolcal eguoment as described below and introduced by t the above application number is in the premises of IV"Ho P-t ':.S 10AE,IA4:; y;Hi)IiN kAIf ss)tiRl; T'ViUlr k;af� in the following location; Q Saseasent t 1st FL LI 2nd FL (:111,. Section Slack Lot was examined on k;Y'1.'N14IiE" .:O 1 4> and found to be in compliance with the National Electrical Cade. FIXTURE ETiCIFTACLp SWITCNEIr COOKI oscics H WA6H9 EXHA BANE OUTLETS R/CANOpC/ /LUORpC/Nr OTNES AMT. ILW. AMT. rI.W, AMT. rc.w. AMT. E.W. AMT, N.F. i V DRYERS FURNACE MOTORS FUTURE APPLIANCE FEibERs SRCIAL 11111W", TIME CLOCK$ SELL UNIT HIATEfts MULTI.OUTLET DIMMERS AMR. K.W. OIL M.F. OM N.F. AMT. NO. A. W. O. AMT. AMR AMR. AMPS. TRANS. AMT. N.F. NO, OFW'ET AMT. WAR! 4 - SERVICE DISCONNECT NO. OF b E R I V I C E METER op MVnM AMT. AMP, TT'n Ewul►. / aW / sw a / >I1N / IW Fnl cc. G No. of NI+Li4 I; NO. of NeunAu 1 Pict OTHER A"ARATUS: (; . F' , E ' . I ; -4 hrt s;tl L3I ;•I'r.lItIkk q I•`G k I�;V F;h 3!;.[.,i, . l H )1•' 1 4d11f " 3:Ari S) . fIt '} l;l "I'I.:3Pi GENERAL MANAGER 9;446 JAI`'PV1d;Y :-11.1' Per This certificate must not be odtered in any manner, return to the *Mae of the Board 11 Incorrect. Inspectors may be Identified by their credentials. CERTIFICATE MUST COPY FOR BUILD[NG DEPARTMENT. THIS COPY OF NUI B LT REU IN ANY MANNER. RESIDENTIAL FINAL INSPECTION REPORT ORice No. (518) 761-8256 Date inspec tiara request received,- Building & Code Enforcement c 4 Dept. of Community Development Arrive am/pm Depart t c Town of Queeosbury Inspector's Initials 742 Bay Road Queensbury. New York 12MM /�.[ y MANSE PE3UvU T # -+"�' t✓ LOCATION ' DATE ' TYPE OF STR C N/A YE." NO CONCV1E1qTS Chimney HeightP713" Vent/Direct Vent Location Fresh Arr Intake Plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Raclin s 0 to 3fi„ Exterior ISandrails, bal , Landing S in. or more Interior Handrails stairs skies 3 6Vmre risers Grade 2% away from fo 'on S" clearance to sill plate Gas Valve shut-off expo for l " above grade Cress Furnace shut-off n 30 e�et or thin line of site Oil Furnace shut-off at entranoe o RMI oe area .401 FtunaeB/H0t Water Beater opera19 Relief Valve(s) installed Headroom +6 fL 6 in. on stairs Basement stairs, 6 ft. 4 in. Handrail exterior stairs both sl4es inke than 3 risers Interior privacy/intn/doorshnam en 36"_ Floor Finish Bathroom/Kitchen watertight Interior Handrails Baleonie sn anding 18 or more Railing across window in stairwells Smoke Detectors! every level every bedrnorn outside every bedroom inter connected Bathroom fans Plumbing fixtures Foundation insulation s/a hour fire door/door closer Garage firwroohn Garage penetrations sealed Furnace in separate room protected. (in garage) Light ventilation per room loe Safety glazing l8" or ess floor Final. Electrical /L! Site Plan/Varian requi-ed. �I Final Survey Plot Plan /�Cs `7 As Built septic System layout required Okay to issue CIC (Certif. of Compliance) Okay to issue temp. C/O (Certif. of Occupancy)_ Okay to issue pexmanent CIO (Certif of Occupancy) t �\ 11 • RESIDENTIAL. FINAL INSPECTION REPORT OMce No. (518) 761,4236 Date inspection request received: Building & Code Enforcement Dept. of Community Development Arrive Depa To" of Queenshury s!a tor's Ini ' f 742 Buy Road Queensbury New York 12804 NAME PERArIIT' LOCATION DATE TYPE OF S1W'ffTLMMq NIA YES NO COMMENTS Chimney Height/"B" Vent/Direct V tion Fresh Air Intake Plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Railings 30" to 36" Exterior Handrails, balconies, lauding 1 or m Interior Handrails stairs both sixes 3 or a risers Grade 2% away f-om foundation S" clearance to sill plate Gas Valve shut-off exposed/regulator 18" ve grade Gas Furnace shut-off within 34 feet or within of site Oil Furnace shut-off at entrance to furnace area FornaceMot Water Heater open Relief Valve(s) installed Headroom, 6 f3. 6 in. on stairs Basement stairs, 6 ft. 4 in. Handrail exterior stairs both sides more than 3 risers Interior privacy/trimldoorshnain entrance 36" Floor Fiuish Bathroom/Kitchen watertight Interior Handrails BalconiestLanding 18 Mi . or met Railing across window in stairwells Smoke Detectors: every level every betkoom. outside every bedroom inter COrinf :ttld Bathroom farts Plumbing fixtures Foundation insulation CyyL t k:)6 0LVrV\ 09Z) ti' G '/a hour fire door/door closer k R C—u ov -'E O� c`� t pT1j 3 �C Garage fireproofing VA Garage penetrations sealed Furnace in separate room protected (in garage) Light ventilation per room ,� t Safety glazing I g" or less from floor �i\ �4E� 3�rC � ' lY > i Final Electrical Site Plan/Variance required. _ Final Survey flat Plan As Built Septic System layout inquired Okay to issue C/C (Certif of Comipliamce) ► } 1�4� Okay to issue temp. C/O (Certif of Occupancy)_ Okay to issue permanent C/O (Certif. of Occupancy} 001111111111111111111iiiiillllllllillllllllIIIIIIIIIIIIIIIIIIIIIIllillilliilliilillllllllllllllllllllllllllllllllllm IX TOW OF QUEEVISSURY gOILDIN6. & CODE EMFORCE"E T 742 Bait Read (Quee, ,s;bvurY 1lY �$C1A (5187 761_8256 SEPTIC QISPOSAL SYSTEM INSPECTION i Name ` J Location yam, p l QerS'I41 t Date ` SOIL TYPE. Sand_Loam-Clay_ Test- Resul is of Pere a � ° Minute/ l nch____� _ ( i f applicable) Rat t.)o o5rN �9 TYPE OF SYSTEM :� al Length �- -- � SORPTION FIEL Length of each rent Depth of trench s Size of stone mber ft . SEEPAGE PITS: f x _ Size - �— -- Stone size _�-- w}z �k PIPING: lank Bldg - Tank to Dist . �ioel d arta a 4li eningsX$eal ed? Y o Op l� f eet LO['.ATION/SEppNpTl to T ank f _ . feet Foundation to Abso tion eet Foundation of pi I4o Separation es Pits at Pl an Conforms as per ts PRO ERIY , LOCATION OF SYSTEM ( circle _ Left S ' de - Right Side Front FRear Middle Rear Mi ddl C AA► A SYSTEM USE AppROVEO = YES ° Arrived: Departed,- Sui ding Inspector fsENERAL INSPECTION REPORT ( 518 ) 761 - 8256 Town of Queensbury Dept, of Community Development Bate inspection request received: Building & Code Enforcement 742 Bay Road Queensbury. NY 12804 Arrive am/pm Depart Inspector's Initials r NAME: PERMIT �i LOCATION: - c_ l DATE ' �� � TYPE OF STRUCTURE: RECHECK. N/A YES Q► COMMENTS FootingSlPiers Monolithic Pour Form Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placemen of the concrete. Materials for this purpose on site Foundationf Wallpoor. Reinforcement in Place _ Foundation/Dam Backfill ?approval Plumbing Under Slab Plumbing VentfVents in Place Rough Plumbing, Rough-In lion Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- Walls ceiling. R- Duct work or piping in unheated. spaces R- Proper Vent, Attic Vent Frarni Jack Studsfli'eaders aracing/Bri Joist hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3, 4 hour Firest+opping. FIRE MARSHAL TOWN OF QUEENSBURY QUEENSBURY, NY 12804 (618) 761 -8205 FIRE MARSHAL INSPECTION REPORT REQUEST RECEIVED NAME rG 5 LOCATION PERMIT SCHEDULE INSPECTION ON A PM APPROVED N}p YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGUISHERS FIRE ALARM SYSTEM FIRE SPRINKLER SYSTEM FIRE SUPPRESSION SYSTE HOOD INSTALLATION INTERIOR FINISHES STORAGE: CLEARANCE TO SP NKL�RS CLEARANCE TO H TING UNITS REQUIRED SIGNAGE CHIMNEY W D STOV _ IREPLAC ❑ MASONRY FACTORY BLT. ROUGH-IN ❑ FINAL REMARKS: 0 OK TO THIS DATE ,/ led D! dG1.�ku�J�; I - ) Ind , ,r,s�s ,P wa INSPECTOR 1 GENERAL INSPECTION REPORT ( 518 ) 761 -8256 Town of Queensbury Dept. of Community Development Date inspection request received: :.Building & Code Enforcement 742 Bay Road Queensbury, PAY 12804 Arrive amlptn Depar#/o , l n� Inspector's Initials NAME: 1 PERMIT it c.1066-- 4 aD LOCATION. 4 DATE : ca Ars C > [ TYPE OF STRUCTURE, RECHECK N/A YES NO COMMENTS FootingstPiers i Monolithic Pour Farm Reinforcement in Place The contractor is respor sibl for providing protection from ng for 48 hours following the p nt of the concrete. Materials for this purpose on si Foundationf Wallpour Reinforcement in Place FoundationMampproofi i3ackW1 Approval Plumbing Linder Slab PXAmbing Vent/Vents in Place wftough Beating Rough-In Insulation Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- Proper.,V,Qnt, Attic Vent .Pack Studs(Ekaders Bracing/Bridging Foist Bangers +� J Jack P'ostsllvlain Beam Air Inliltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed ire Wall 2, 3, 4 hour Firesatoppsn TOWN OF QUEENSBIlRY TOWN OF QUEENSBURY 3� ) � BUILDING . _ CODE ENFORCEMENT BUILDING A CODE ENFORCEDMT 742 Bay Road 3 742 Bay !toad Queensbury NY 1_2804 Queensbury NY 12804 (519) 761-9256 (519) 761-82% SEPTIC DISPOSAL SYSTEM INSPECTION SEPTIC DISPOSAL SYSTEM INSPECTION Name ` Name ' Location D y x. Location , 3�` 3o,'\rti Y� i Date 4 r~ =�{3D Fermi �j Date Permit # SOIL TYPE : Sand- Loam- Clays ©� ` SOIL TYPE: Sand- Loam-Clay-Results of Percolation Test- Results of Percol-ktion Test- ( if applic te-Minute/Inch ( if applicable ) Ra e-Minute/ c'h�` TYPE OF STEM: TYPE OF SYSTEM!: 1 ABSOliPT ON FIELD : To 1 Length ABSORPTION FIELD: To 1 ength ZS'� Length of each trench Length of each trench Depth f trenches Depth of trenches Size o stone Size of stone A�5- SEEPAG PITS : Number- SEEPAGE PITS : Rum'ber- Size - to x ft . Size - fto x ft0 Stone si a Stone size PIPING : i z e ype PIPING : Size Type Bldg , to ank ►,rta y' � Bldg . to Tank Tank to Di t . Box r 1 - 5'+c' # Tank to Dist . Sox Dist . Sox Field/Pit Dist . Box to Field/Pi 4Vle Openings Sea ed ? . Yes No PartialOpenings Sealed ? es No Partial LIX.ATION/SEB LOr.ATION/SEPARATION Foundation to ank feet Foundation to Tank feet Foundation to sorption feet Foundation to Absorption feet Separation or Pi s 4E t Separation oy Pits feet Conforms as per of P1 Yes Conforms Separati as per Plot Plan Yes No LOCATION SYSTE ON , ROPE LOCATION OF SYSTEM ON PROPERTY: ( circle one ) ) r_ ( circle one ) Front - ea - L f t We fight Side Front - Rear - Left Side - 'Right Side Middle 'Frrnr+ idd a ar Middle a Front - Middle Rear COMMENTS * COMMENTS ; SYSTEM USE APPROVED : YE No SYSTEM USE APPROVED : YES Arrived : Depart f Arrived : 2 } Departed : fllding s ectorP Building Inspector h : GENERAL INSPECTION REPORT ( 518 ) 761 - 8256 Town of Queensbury Dept. of Community Development Date inspection request received: Building Biz Code Enforcement 742 Bay Road Queenshury, NY 12804 Arrive am/ptn Dregarp Inspector's Initials f NAME: c.� e. PEPjvflT - LOCATION: 13ATE : � Cc aP,� TYPE OF STRUCTURE: RECHECK r` NIA YES NO CON EENTS Footings/Piers Monolithic Pour Form _ Reinforcement in P The contractor is nsible for providing otec m freezing for 48 hours foll g dievi,4icentent of the concrete. p Materials for this rpose on sites Foundauon/Wallp*r Reinforcement in P ace Foundation/Darapptoofing. ckfiill Approval ; Plumbing Linder Slab;__ Plumbing Vent/Vents 19 Place Rough Plumbing Heating Rough-ln Insulation Foundation Walls Interior Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- Proper 'Vent, Attic Vent Franti Jack Studs/Eleaders Bracing/Bri Joist Bangers Jack Posts/Main Beam Air infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3, 4 hour Firestopping Faberge Group 518/458-7112 "1 have seen or observed, or believe i saw aridm A all objects such as houses, wells, trees, fences, Or shown on this document. I also represent that 4 hove NO _C�Vy\ts 01 Zabt O�monmr personally measured the distanees Lo 3 -So 5urrt1 Ci\ 5r" aal t, I cimil for\ a CCAr garcwj� .....�y �� � ' SIGNATURE A) 6C'fo'�C slat S 98 20'2 " : E 7,{ . . 70.01 ` 70,a1 o ". 10' --- — Q APIP - -- Q F 71000r9 sq. T tr 11000r 72 7qr T �r � 00Vr J / 1000 1G �qr 1 4r 8J3 0 0 Q 0 0 a = p T r CO in y 7 = d J 4.7 70. 01 --- ._ . . . _. w. 70.01 16 a 00 0 v S 89'20'27" Eift AP* dft dub w _� T ftir . n' T 7n AO' AT 74.E