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2012-220 TOWN OF QUEENSBURY 742 Bay Road,Qucensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120220 Date Issued: Thursday, May 10, 2012 This is to certify that work requested to be done as shown by Permit Number P20120220 has been completed. Tax Map Number: 523400-309-014-0001-013-000-0000 Location: 2 RYAN Ave Owner: PATRICK MERRILL Applicant: PATRICK MERRILL 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, BVI �.� Variance, or other issues and conditions as a result of approvals by the Director of Building& Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 IFA Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20120220 Application Number: A20120220 Tax Map No: 523400-309-014-0001-013-000-0000 Permission is hereby granted to: PATRICK MERRILL For property located at: 2 RYAN 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: PATRICK MERRILL Septic Alteration Residential 108 MAIN St Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2012 $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, May 04, 2013 (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 Town of sbury; A Frida , ..y 04, 2012 SIGNED BY itaV for the Town of Queensbury. • Director of Building&Code nforc\ ent �, Revised 4/14/2010 OFFICE USE ONLY 1 i�1 --TAX MAP NO3_6_9,14(-`--13_PERMIT NO. �J PERMIT FEE 4 I D t U I"�A 0 a CU12 ,' !' • APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: T°BUM! (),;,!,_ _:DDES A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALIDIPERMIT.' ' OWNER: I� J //�v�tX&. INSTALLER: 4/14,'vwwtti ` t t. _ `J74.: ADDRESS: 0a L( i}i,,,,,xt P-0 ADDRESS: /O `) �J21 Q c6 A t>/ J,d� PHONE NOS. 79 3 E>9// Z PHONE NOS. 4 !! 7Q'j Z.2 cZo . 7,5,6\134 LOCATION OF INSTALLATION: 1 pl. r`'��0 C.%4X.-- .,,...-4...,�� ((11 RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older 3 X 150 = 271 3'0 INSTALLED? i4-, 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = _ INSTALLED? /tom PARCEL INFORMATION: ✓ TOPOGRAPHY: CROLLING STEEP SLOPE %SLOPE ✓ SOIL NATURE: ',ND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? C <,...,--- ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? E -fes ✓ DOMESTIC WATER SUPLY: gare WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS PER MINUTE PER INCH[mph (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: /deo 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. SYSTEM TYPE: 0 ABSORPTION FIELD(WITH NO.2 STONE) Total length /8O ft. Each trench 30 X ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? 0 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 Sanitary Sewage Disposal Ordinance. codes(a.queensbury.net -77.--.-P-g- G 4,--(2,-w VISIT OUR WEBSITE FOR MORE INFORMATION Signature of Person Responsible Date www. _ queensbury.net Town of Queensbury * Community Development Office * 742 Bay Road, Queensbury NY 12804 Septic Inspection Report Office No. (518) 761-8256 Date Ins.- ion r-. c- �• Queensbury Building &Code Enforcement Arrive: a': - ,�• part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initi. : . c NAME: kAEQV-\ l ' RI IT NO.: \2-- Z7-0 LOCATION: Z R �w1 Rl\E- N •ECT ON: 5-ltd—\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 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 Opening Sealed: _Y N End Cap _Y_ N Inlet/Outlet Pipes&Baffles _Y N Manholes 12"or less below grade Y_ N [provide extension collar if Yes] Y_ N R I 117 t. 4' t° Location / Separations Foundation to tank ft. Foundation to absorption __ft. Separation of Pits ft. Conforms as per P : • a _ N Engineer Report an As-Built Y_ N ETU Maintenance • . Y N provided Location of System on Property: Front R r Left Side Right Side Middle Front Middle Rear S stem Use Sta s: 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 Report03 29 10.doc 05/09/2012 13:40 5187932115 MORNING STAR SEPTIC PAGE 01/01 518-793-2290 00, Fax#518-793.2115 N2 4 5 1 E-mail:momingstarseptic@hotmail-corn www.momingstarseptic.com SIRVNC* Date: -7711,4, — l 7L . V"4� 107 Jewel Rotd,Gansevoort,NY 12831 TO: ��JJ P a MAP 020\zo 2ao s BBUILT • A © C c r p - 34-' I ` ( A6 621 ' A c - 3 3 D — .''��, ) .l.AJL a a c ./0-LA ceate,t) Septic Inspection Report Office No. (518) 761-8256 Date Ins•-ction r-. .- -•eiv-:: — Queensbury Building &Code Enforcement Arrive: I!! fertit• 'epa• . j Z- t a • •m 742 Bay Rd., Queensbury, NY 12804 Inspector's Initial • r_ NAME: MAS r 1 J J P-•MITNO.: /Q - LOCATION: A C .cam P' V e INSPECT ON: — $ -1 a RECHECK: Comments and/or diagram Soil Typ_• ... oam / Clay Type of WaterWell Water Wate • ration distance 10 ft. —1— Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length ICS ft. Length of each trench ,570--2.A) ft. Depth of trenches 2— ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank LA..% ..1-)CA-1 Lk b Tank to Distribution Box 1-'1 NC_ Distribution Box to Field / Pit A l' Q C I(() ()F.c?-- -a Opening Sealed: N End Cap V N Inlet/Outlet Pipes N Pe &Baffles _ q/Y...— Location/ Separations ‘__k ,;;,.)F Foundation to tank 7 ()4 ft. 6pge. -, Foundation to absorption .5- ft. _ Se•aration of Pits ft C� k a VT -C&lu Conforms as per PllakkaanraIN Engineer Report a a As-Built P Y Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: _____e pproved V T—C) uilS� LL— Partial � Partial Approved and needs to be re-inspected, please call te Ing & odes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc A 518-793-2290 Mk Fax#518-793-2115 NQ 370 , ; E-mail: morningstarseptic@hotmail.com 1—^::y"rc www.morningstarseptic.com ■■ CTC) _Z PT•C •RRVIC n J ��1`L e� Date: f�n, nn , 107 Jewel Road,Gansevoort, NY 12831 C"1r. i TO: Y�- '/)1+try Y i .1119°IL: M A P «%-,-- ....„,...„...„,:....61.4.,.. A,%, -? ._. . ,F, _ . Di"„..,„ P1, r1cf , \a I. ,, i : /� ! . TOW, ' OFQUE- ''S �,, I1 _ - - -� .. i , BUILDING & .• D74 pig"z'. I° �' 3a - Rev ed B . /�/ ��,/ I sZ Date: JANIIII kfr , • t , \ ift )0 -t- • HIS PLAN TO BE O I '11- , PROJECT SITE AT a't ALL TIMES FOR �4 _:f ntc ,nri- . e, THE DURATION OF All CONSTRUCTION -3"/7--- 6