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2015-148 TOWN OF QUEENSBURY t--44w 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150148 Date Issued: Friday, May 22, 2015 This is to certify that work requested to be done as shown by Permit Number P20150148 has been completed. Tax Map Number: 523400-301-020-0001-017-000-0000 Location: 4 EISENHOWER Ave Owner: JO-ANN BRUCE LIFE USE Applicant: TRACY BLANCHARD 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 /f 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&Code nforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY A 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 FOS Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150148 Application Number: A20150148 Tax Map No: 523400-301-020-0001-017-000-0000 Permission is hereby granted to: TRACY BLANCHARD For property located at: 4 EISENHOWER Ave 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: JO-ANN BRUCE LIFE USE TRACY BLANCHARD Septic Alteration Residential 4 EISENHOWER Ave Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications BP 2015-148 Tracy Blanchard Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,May 08,2016 (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 To n of ens ; i• , ay 08, 2015 �d • SIGNED BY , for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT ' ---�-9- �- (� Office Use Only ;�.� �" Lam' f I �llj jam; DATE S , . ,I, Lam, `eeived 111111 Map ID 30�. .2D -1-l r TAX MAP ID 301.)6I .-t-l j MAY 0 8 2015 mit No. • 12C?l5-1 Lf T,�yW P:rmit Fee #CIS, 070 LOCATION OF INSTALLATION //1'N :.dn.L.,QUEENSBURY A,provals: - • ODES -f-Nazy- APPLICANT / �1/i4"0.-c/ _/ PHONE/E-MAIL ADDRESS G/ /� �t Ses�7 0lv-t%" Ar. . INSTALLER/BUILDER: SyN/.�� Lred'v"eP ,/-fic C PHONE/E-MAIL ADDRESS: k 4 2CT( 'rr / /,i / /2I / OWNER PHONE/E-MAIL Address I �� CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: .CS)C G���� � PHONE /r-6.---.1 7o O RESIDENCE INFORMATION Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow 1980 or older / 5 V V S1,) Garbage grinder installed _Y N 1981-1991 Spa or Hot Tub installed Y ' N 1992-Present PARCEL INFORMATION Topography Flat rolling Steep slope %slope Soil Nature Sand Loam Clay Other Groundwater At what depth? /1/-� Bedrock/Impervious Material At what depth? /i// l- Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate: /- S per minute per inch(test to be completed by licensed engineering/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank Size /GZ'Z) gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub) System Type Absorption field with#2 stone Total length 2"v' . ft.; Each trench S C% ' x (/. Seepage Pit with#3 stone How many: ;size Alternative System Bed or other type? Holding Tank System Total required capacity? Tank size #of tanks Notes: 1)Alarm system& associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system layout on file—no exceptions. DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations and agree to abide by these and all requir ents9 the Town of Queensbury Sanitary Sewage Disposal Ordinance. Print Name: C��S � -� Date: J_- Y - /I Signature: -�'� 7" � .r�� Date: 1 - —/I-- Town of Queensbury Building&Codes Septic Disposal Permit July 2014 I own Queensbury Building & Code Enforcement Office No. (518) 761-8256 1 -3 Septic Inspection Report Inspection request received: S\xgI tis Name: 6\04vzCk,c,\,rd Inspected on: I 2-11 2• Location: 69&11-1QatJQ,✓ Arrive: \ ©ia Permit No.: 1t— Vtb Inspector's Initials: _I�' Co ments and/or dia•ram Soil Typ . San o. Type of er: •,.�',�ellWater Waterline se. istance 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 '2.� ft. Length of each trench .1-{ft✓ O ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank 1.-\' . bC 4-0 Tank to Distribution Box ti t1 ,M)12.-?36— Distribution D12.-Distribution Box to Field/Pit 4rt ,o ! S7r Opening Sealed: �/1' N End Cap ✓/Y N Inlet/Outlet Pipes&Baffles ✓ Manholes 12"or less below grade [provide extension collar if Yes] Y ✓N Location/Separations Foundation to tank 1-(. ft. Foundation to absorption Lam' I ft. Separation of Pits ft. Conforms as per Plot Plan Engineer Report and As-Built Y N ETU Maintenance Contract provided Y N Location of S stem it 'rope : Front Rear eft Side Right Sid Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report FILE COPY TOWN OF QUE. , .B - ' ,� M. _ � , BUILDING & ' ••D'/ '.� Reviewed B . • Date: D � / r . . SEPTIC PLOT PL ZS OBSERVED ALL OBJECTS I HAVE SEEN OR OBSERVED TREES,FENCES,ETC G , SUCH AS ON HOUSES,DOCUMENT. _ I1 SHOWN THIS ERTH ON THIS DIAGRAM.OL� MEASURED THE DISTANCE r1'Y si�'� / E DATE S " ATl1FtE �� C� w __._ !01)0 ba F-71) 'in' f. _ ,�` Go c=v1 f ow �� C 1401.0? o +mac c