RC-0140-2023 J 4
Office Use Only
4' j5 1 ADDITION/ALTERATION PERMIT Permit#: tC• 'B 140 • lO 2.3
Town of Quecn APPLICATION Z?0 — •
Permit Fee:$.
742 Bay Road,Queensbury,NY 12804 •
P:518-761-8256 www.queensbury.net Invoice#: 5(e
Flood Zone? Y IP Reviewed By:d
•
Project Location: 69 arcids, /ic �xr e / /0V, ltiC
Tax Map ID#: Subdivision Name:
PROJECT INFORMATION:
TYPE: U'.Residential ❑ Commercial, Proposed Use: •
Ingle Family ❑ Two-Family • ❑ Multi-Family(#of units_) ❑ Townhouse •
❑ Business Office ❑ Retail ❑ Industrial/Warehouse ❑ Garage (#of cars
❑ Other(describe
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: \" 2nd floor:
•
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space): `°
Total sq ft: Total sq ft: 01
Scope of work to be done: ! t( "yhet ro0,4\._ •, ry ivtbvtit,C)
•
l old -`�
04 �r.��
role $s ! l
sal ate` ; f
• Addition/Alteration Application - Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ IC). C (:) C5-3
2. Source of Heat (circle one): ❑ Gas z6il ❑ Propane ❑ Solar ❑ Other:
Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? ❑ YES E1110 Explain: •
4. Are there any easements on the property? ❑ YES 1a-110
SITE INFORMATION:
• Is this a corner lot? ❑ YES
• Will the grade be changed as a result of the construction? ❑ YES E lii
• What is the water source? ❑ PUBLIC LRIVATE WELL
• What type of wastewater system is on the parcel? El SEWER ❑ PRIVATE SEPTIC
DECLARATION: _
1. I acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period.Any changes to the approved plans prior to/during construction will require
the submittal of amended plans,additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn,30%-of the fee is retained by the Town of •
Queensbury.After 1 year from the initial application date, 100%of the fee is retained.
3. If thework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. I certify that the application, plans and supporting materials are a true and a complete statement and/or description
of the work proposed,that all work will be performed in accordance with the NYS Building Codes, local building laws
and ordinances, and in conformance with local zoning regulations.
5. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: •
SIGNATURE: DATE: 11/173
•
Addition/Alteration Application Revised June 2022
•
r
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): 0Y\ uoe *--L)r 6✓ctrc>v-1„,a 6 zu1`ro',!
Mailing Address, C/S/Z: 15" ►�. ,v✓s,~Dw 3)—U •nct,`V"r, c/o' 5 A--r de,S'✓, �' ,t)K ,4i G
Cell Phone: ('3t ) 7,6 —9 2'I Land Line: ( 5l g- ) 5 7
Email: ;LeG,t?6.4h,-5 47M . Ca-�
• Primary Owner(s):
Name(s): AAn i kn..?0
Mailing Address C S Z: ?ark
Cell Phone: ( ill? ) '54./ 7 Land Line: ( )
Email: Knotpp C.oe59;T r 2,; t ,('stir►-.
❑ Check if all work will be performed by property owner only
• Contractor(s): (List all additional contractors on the back of this form)
Contact Name(s): iN 5iM f Mo-4
Contractor Trade: -e•^.k
Mailing Address, C/S/Z: i �, i���s,v«,. t` S,: t—C C31 ; try = 59', s(
Cell Phone: (alb ) 3 Fte() Land Line: ( S►rY ) ice—
Email: /%iart/b'► e
**Workers' Comp documentation must be submitted with.this application**
• Architect(s)/Engineer(s):
Business Name: -
Contact Name(s):
• Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
Contact Person for Compliance in regards to this project: Maik r L ✓tL2o '
Cell Phone: ( J4 ) Land Line: (j-J- ) 587- 03
Email: /net l/gin g 04-5) 54fen , 6.6,frt
•
Addition/Alteration Application Revised June 2022
ec -0 Az- 202�
GARRY ROBINSON, P.E.
CONSULTING ENGINEER
114 MONUMENT DRIVE • SCHUYLERVILLE• NY • 12871
PHONE&FAX: 518-695-3655 • CELL: 518-796-4265
EMAIL: grobinsonpe@gmail.com ��Z3
I
V IJuly 13,2023 �rG,
Craig Brown, Director
Town of Queensbury, Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804
Dear Craig,
Re: Site Inspection, Onsite Septic System Certification
69 Brayton Lane,Assembly Point
Town of Queensbury,Warren County
As part of a permit application for the subject residence for a new bathroom to be installed in the
basement of the home,we understand that an inspection of the onsite septic system is required. As such in
early June we inspected the site of the subject home. By, way of foil request we received the onsite septic
system design plans that were submitted for a permit prior to installation in October of 1997 as well as the
undated as-built plans. Both sets were prepared by the contractor in 1997.
The existing system included 6 leach lines @ 42' each or 252 If of leach lines. Although we don't know
the perc rate of the existing soils, it appears as though the system as designed can handle 3-4 bedrooms of
generated sewage flows. The site plan showed the location of the proposed system and indeed it was
located where shown on the plan (plans attached). The system is a pumped system. The pump station is
just outside of the building right after the septic tank. Both the septic tank and the pump station were
visually inspected and appeared to be working properly.
The owner of the property purchased it in in 2020 and it is not the owner's main residence. She was not
aware if the septic tank had ever been pumped prior to when she bought the place.
In late July of last year,the pump failed and had to be replaced. As part of the repair project the septic
tank was pumped. At this point everything is working properly. In addition,when the property was
transferred a property transfer inspection was completed. The inspection was performed on 10/29/2020.
It tested all components of the septic system and it stated that everything was functioning correctly.
As a result of our inspection,and based on our review of the design plans and the as built plans provided
by the Town of Queensbury,we believe that the system is in good working order. We hereby certify that
the system meets current day design standards. We do recommend that depending on the usage of the
home during the year,the septic tank should be p Ode - years.
If you have any questions or require any furth iiif ,gn�tiof?fp•.IN L Ili s� .-el free to give me a call.
Sincerely, `' - •2- �(2
cT 9 A ,''''i! iii0;6* \ ,
Garry Robinson, P.E.-Consulting Engineer V`
NYPE#060166 e� '`
Cc w/att: Joe Darrow HP2017/C/MyDocs/NlyWoreots/OOn`siieSepiles/QueensburyCertificationsRCnappOnsiteSepticsysteminspection