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2011-331 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: P20110331 Date Issued: Wednesday, December 19, 2012 This is to certify that work requested to be done as shown by Permit Number P20110331 has been completed. Tax Map Number: 523400-296-010-0001-064-000-0000 Location: 3 ST. ANDREWS Dr CLARK & LINDA MC MAHON Applicant: CLARK &LINDA MC MAHON 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 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&eode En orcement 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: P20110331 Application Number: A20110331 Tax Map No: 523400-296-010-0001-064-000-0000 Permission is hereby granted to: CLARK&.LINDA MC MAHON For property located at: 3 ST. ANDREWS 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. Tne of Construction Value Owner Address: CLARK&LINDA MC MAHON Septic Alteration Residential 3 ST. ANDREWS Dr Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011-331 septic alteration residential $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,July 06,2012 (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 Tow ueen Vyed7 ,July 06, 2011 SIGNED BY 6-7 for the Town of Queensbu ry. Director of Building&Code Enforcement .. OFFICE USE ONLY f 3 �f TAX MAP NO "/ 1 PM NO. 3PERMIT FEE 7 JUL 0 5 2011 APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERI V117TOWN OF QUEENSBURY .:..._BUILDING& A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION ISSUANCE OF A VALID PERMIT. OWNER: /1'•.r•n�e {�/1.L I\Aat�0I-) INSTALLER: 6V /6/ Al(.L& Cor! ADDRESS: 3 ADDRESS: PHONE NOS. — l t I " 4 v PHONE NOS. LOCATION OF INSTALLATION: RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS Gallons per bedroom GARBAGE GRINDER 1980 or older X 150 = INSTALLED? 1981-1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? ,PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT RO'LLLING STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND \l LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT.WHAAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL V WELL (If well:water supply from any septic system absorption is: ft) 1 / ✓ PERCOLATION TEST: RATE IS !-S PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional engineer or architect) 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). TANK SIZE: V GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,spa or whirlpool tub. •11-.� t ro ,s�-. SYSTEM TYPE: ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X fiiSEEPAGE PIT(S)(WITH NO.3 STONE) How many? Z Size? A&.4- ❑ALTERNATIVE SYSTEM Bed or other type? ❑HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 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 QUESTIONS? CALL 761-8256 OR EMAIL SaM7 S wage Dispo al Ordinance. codes(a)aueensburv.net N ( VISIT OUR WEBSITE FOR MORE INFORMATION Signatu D a of Person Responsible ate i www•aueensbury.net Town of Queensbury* Community Development Office*M2.Bay Road, Queensbury NY 12804 Septic Inspection Repoli Office No. 518 761-8256 Date Ins ctio uest received: l Queensbury Building &Code Enforcement Arrive: am pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspects Initials:- NAME: 0'k6V� �1 uC `D PERMIT NO.: e�-f LOCATION: 1� INSPECT ON: RECHECK: Comments and/or diagram •�� Soil Type: Sand/ Loam /Clayl�e S Type of Water: Municipal/Well Water Waterline separation distance ft. &re, f, n Well separation distance ft. Other wells: ft. Well Casing Length 50' +/ - Y N N/A 150'to well required if NO Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x /0 Stone Size: ' Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: Y_N End Ca Y N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade Y—N [provide extension collar if Yes Y N Location/ Separations Foundation to tank ft. ����G� L5X1127-IA) j, of Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _Y_N Engineer Report and As-Built _Y_N ETU Maintenance Contract Y_ N provided Locatio of System on Property: Front Re Left Side Right Side Middle Front Middle Rear S stem tat Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection ReporL03 2910.doc Septic Inspection Report Office No. (518)761-8256 Date Insp�gn request received: Queensbury Building&Code Enforcement Arrive: ! am/ Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: PERMIT NO.: f 3 LOCATION: INSPECT ON: Z 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. Well Casing Length 50'+/- Y N N/A 150'to well required if NO Absorption Field: Total length ft. Length of each trench A. Depth of trenches ')ft. Size of Stone { Seepage Pits: Number Size: x Stone Size: i_ Piping Size Ty'pe Building to tank 4.1 Tank to Distribution Box v Distribution Box to Field Pit 14 Opening Sealed: Y j End Ca _Y N Inlet/Outlet Pipes&'BafFles Y N Manholes 12"or less below grade Y_N [Provide extension collar if Yes Y 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 ETU Maintenance Contract Y_N provided i Location of System on Property: Fron Rear Left Side Right Side Middle Front Middle Rear System Use Status- -W-Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved LAPam Whiling\2010\13ullding Codes Forms\Inspecdon Forms\Septic Inspection ReporL03 2910.doc n Septic Inspection Report Office No. (518) 761-8256 Date In7s4 on request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm 742 Bay Rd., Q sbu , NY .12804 Inspectitials: NAME: PERMIT NO.: LOCATION: INSPECT ON: �—1 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. Well Casing Length. 50'+/- Y N N/A 150'to well required if NO Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: l �L y G Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field Pit Opening Sealed: Y N End Cap Y N InletjOutlet Pipes&BafFles Y N Manholes 12"or less below grade _Y_N [provide extension collar if Yes Y 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 ETU Maintenance Contract Y_N provided LocationDront ern on Property: 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 L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection ReporL03 2910.doc BUILDING Reviewed a n EPT' YK, Da to- Wu .✓400 66 0 Y, U Nx4b C' COI Q -1 .. 1,� ;,; & t REViE1rVED BY ` >. DATE '