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2015-381 TOWN OF QUEENSBURY tem 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150381 Date Issued: Wednesday, August 26, 2015 This is to certify that work requested to be done as shown by Permit Number P20150381 has been completed. Tax Map Number: 523400-309-010-0002-013-000-0000 Location: 9 RICHARDSON St Owner: DAUCHY G. POOLER Applicant: DAUCHY G. POOLER 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&Code Enfor ement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY #1111fti tOiro 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150381 Application Number: A20150381 Tax Map No: 523400-309-010-0002-013-000-0000 Permission is hereby granted to: DAUCHY G. POOLER For property located at: 9 RICHARDSON St 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: DAUCHY G. POOLER Septic Alteration Residential 9 RICHARDSON St Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency IBS SEPTIC &DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY,NY 12804 Plans&Specifications 2015-381 Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 25,2016 (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 T o ueen ry4 1 e , - ugust 25,2015 SIGNED BY ' \ for the Town of Queensbury. Director of Building&Code Enforcement - Cormingqty D v&ooment Office Town of Queensbury . 742 Bay Road = Queensbury, New York .12844 Office Use Only TAX MAP NO.'JOc1• l®-2 -\3 PERMIT NO. I5-5Z\ PERMIT FEE V ck APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS_APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: ,---)01.--t P QQ\�(- INSTALLER: .—G 5 V 1 ( ADDRESS: 9 1\,(r.or cern 5-i- ' ADDRESS: 2 1�( erV'J <1 i(`Q r"J\' ' PHONE NOS. 1 9-9-- 64.'6 I PHONE NOS. `-1' y \ t.) C} LOCATION OF INSTALLATION: 1 v 4i1,-,j r cbci 5} RESIDENCE INFORMATION: NO. COMPUTATION TOTAL DAILY FLOW YEAR BUILT BEDROOMS X (Gallons per bedroom) GARBAGE GRI D1R 1980 or older X 150 = 1 ) () INSTALLED? 1981 -1991 I IV X -- 130 = 1\J 1'1' SPA OR HOT 1992-present \V�- xi 110 = 1\( 'I INSTALLED?�`� PARCEL INFORMATION: E C l� O �7 2 ✓ TOPOGRAPHY: FLAT ROLLI GSTEEP SLOPE %SLOPES r [� ✓ SOIL NATURE: SAND \ 11L�OAM\ \ CLAY \ 0 i ► 1 6 2 1 2015 ✓ GROUNDWATER: AT WHAT DEPTH? 1 V ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA DEPTH?`�r �� TOWN OF QUEENSBURY 'DI !!! r;i\Ir,. 0 r'nDES ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL 1�V iX(If well:water supply from any septic system absorption is: ft)�"�`"" V PERCOLATION TEST: RATE IS ,V PER MIINUTE PER INCH[mpij (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). n e+; )-i— TANK SIZE: �'s1�iC GALLON-WIN.SIZE IS 1.000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. SYSTEM TYPE: ,l ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length\q t 1 ft_ Each trench 5 )(')c -erN 5-he 0 SEEPAGE PIT(S)(WITH NO.3 STONE) How many? LV \\ Size? W �C ❑ALTERNATIVE SYSTEM Bed or other type? U( o HOLDING TANK SYSTEM Total required capacity? 1 � Tank size? 'v Number of tanks?\\ i'--- 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 any: requirements of the Town of Queensbury / QUESTIONS? CALL 761-8256 OR EMAIL Sanitary S a Ji4sposa1 Ordinance. i ( cctes@)cuaans,usv_nst ��� `c VISIT OUR WEBSITE FOR MORE INFORMATION Signa on Responsible Date www.cueensbusv/.n et Town of Queensbury Building & Code Enforcement Rr6i7t Office No. (518) 761-8256 , Septic Inspection Report �M p p p Inspection request received: Name: �pn© Inspected on: 410 Location: tom\ Cr\0-2s)p)t �V. Arrive: i�/ p.m. Permit No.: ��j — �$ l Inspector's Initials: ll!P C Air nd/or dia'ram 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: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Op ing Sealed: Y dCap Y nlet/Outlet Pipes&Baffles Y Manholes 12"or less below gradeN \l [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 provided Y N Location of S stem on ' o.e : Fr. t R:.r Left Side Right Side Middle Front Middle Rear S ste se Stat : Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report Town of Queensbury Building & Code Enforcement A (.1,6cS. Office No. (518) 761-8256 21. Septic Inspection Report Inspection request received: 6`Z5)2QIS Name: 1 Oa / Inspected on: • Z� �• ,411P Location: 1 b dinck,v8Sciv-I Arrive: 7 -9:".1111r27%.,/ a. . .111 ,> Permit No.: 15- \ Inspector's Initials: In' o "ents and/or dia•ram Soil T e: Sand ..u /Cla ,Or Type of ate . V unicipal/ •II Water 2 Waterline separation distance ib ft. ' r 1 `�Q 2 3 Z Well separation distance ft. Other wells: ft. `NQ\�"� Well Casing Length 50'+/- Y N N/A t%*�' g [150'to well required if NO] ion ' q A Absorption Field: Total length Ictct ft. All00116(j) Na. Length of each trench 5-35 y;\E �ft. � k4 ttcr '"tet Depth of trenches 3 -14 ft. 1 �-- ___`__—_ Size of Stone ufiR1J5.o T Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Lvi F___)06 Tank to Distribution Box Lk" 602 5 Distribution Box to Field/Pit / L„�•� {J oR s- Tb «bQ�v 9� , Opening Sealed: �(Y NN End Cap j v 'v t-7=-%-)V 1_DOQ�� 4\ CAISP1C \---.• Inlet/Outlet Pipes&Baffles Manholes 12"or less below grade i//N [provide extension collar if Yes] N -`' ç •Location/Separations ._ L3. t'l-' l O fbTgl- Foundation to tank EY-01-ft- Foundation to absorption ft. , Separation of Pits Conforms as per Plot Plan y N Engineer Report and As-Built VY N e-FG,\ v_Q i -c tC� ETU Maintenance Contract provided Y N Location stem on Prope : 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 Septic Inspection Report4.) -a0/7 i 'b'`r' GQ/ 1-4617 -1 „ /9— _4 0 sr,cp, d a`f�j/ 1„ 1 s1�;:e o� d.rn N lro )(/!'r/ © int `l' /() Yw 1 • ■ nimumnionaimmommounmonn ■/■■■■■■■■■ ■■/ ■ _- 1111■■■ _ ■� 1111 i / 11//11 � / , pan■ ■/,m , ■ ■■'■�% 1 - 11!�►,�� , l - /■ �'-r''i 1111/■■ � --__N 7 . 21 �■■ ,�La�; .� � ■11 _� _� ilii■■/■ � - �. 11111. ma c; commte 1 ommummn Nk.14 - 1 -'-' pans" I 1 111011111111.11111 I .. -■ 1� � �•11■ Iii/ 1 111 _ ..t■r 1111■■/ 1111Lict_ Said1111111111 4,i nal i� ■C /�' 11 - ! ■■■11 i_ ■ ■ .�III1'l'llili ■11411 ■rr/,�,■��i:i� �-11 11 ■ ■■..men` —,—':!■■r■ ,D - � ■■■■11 _--_. ■�r■r■■mum - .1-c, i■■■ o■ j /■H►/11■ C ■ �■■�■■ immunnweit ;____i / 11/11/ -- ' Imo -7---/11/�j11 1111424 --:__ '- 1 111111111111111111 ■11.- n - „ ,!■■ . � � _ � � ,,�■►�,iiiIII!i' ■ inimmo � ■ 1111■ _ ■ 11■� 1111111 ! i 11/11 ■■■■■■aw 1111111 ___,� 1111 �■11� iiiiii 1_:__ i IIIiiiiiiiiiiii __� � ■■a■11numnou a____L ; 1 1111■■■ ■ R n_ -� //■■�■■e■ , it-ht- ■ 11/■/1111■■, /■■■11■ ■■■ NI ■, ■■■1111//, ■■///B■11■11■ ; ■■1111/11 ■ 11/■■1111■■■■11■h111m■■■ ■■■ ■ mu■■■111111■11■■ NI 17 _Li nt ,--- - ! i