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2012-472 OW, TOWN OF QUEENSBURY 742 Bay Road,Qucensbury,NY 12804-5902 (518) 761-8201 41.11. Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120472 Date Issued: Friday, August 30, 2013 This is to certify that work requested to be done as shown by Permit Number P20120472 has been completed. Tax Map Number: 523400-239-016-0001-001-000-0000 Location: 5 GREY LEDGES Dr Owner: THOMAS & JUDE CATLIN, TRUSTEES Applicant: THOMAS & JUDE CATLIN, TRUSTEES 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 4 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 Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,(1uem.d)Ury,NY 12804-5902 (518)701-82,01 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Pet-mit Numbei-: P20120472 Application Number: A20120472 Tax Ntap No: 523400-239-016-0001-001-000-0000 THOMAS & .UDE CATLIN. TR[J STEES For Property located at: 5 GREY LEDGES Dr in the'l'0W1l Of QUeCtisbury, to construct,ur place at the , above location in accordance with application together with plot plansand other inforn-lation hereto Filed and approved and in cornpliance with the NYS t-7niforril Building Codes and the QueenSbUry Zoning Ordinance, Type of ConstrIaCtiOn value Owner Address: THOMAS & JUDE CATI-KTRUST Septic Alteration Residential SARAH CATLIN LANDERS, 'I'RUSl I'mal Value 17C FAIRWAY Dr Mf,'C]-IANICVILLE,NY 12118-OOOC Contractor or Builder's Name / Address Electrical Inspection .Agenic} ELLSWORTH & SON EXCAVATING 57 E'LLSWORTFI Ln LAKE GEORGE1, NY 12845-0000 Plans & Specifications 2012-472 Res, Septic Alteration S40.00 PERMIT FEE PAID-TT-TTS PERMIT EXPIRES: Thursday, September 26, 2013 (If a longer period is required,an application for an cxteo,%ion must be made to the code Enforcem"it Officer of tine Town of Queensbury before the expiration date.) Dated at the Town of Queensbury; Wednesday, September 26, 2012 S I(;N ED BY for the Town of Queensbury. Director of Building& Code E'nforccment Community Development Office Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only Q, TAX MAP NO. 3 1 , I (A — I—) PERMIT NO./ IN?c7.. PERMIT FEE _ 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: 7,10,E c s COSH(.n INSTALLER: E/IS INOr iA 4 BOA S ADDRESS: S Gel/It) De ADDRESS: 6/fS01 Lav ee Lok( 6eo- PHONE NOS. 65-4 -5 7A f 60- 194g PHONE NOS. ?IA- 9 ) / LOCATION OF INSTALLATION: s VC/ 5-6 .9R) po ate 9L RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = 360 INSTALLED? A/6' 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? NO PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING / STEEP SLOPE %SLOPE ✓ SOIL-NATURE: SANDL AM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? i\J ✓ BEDROCKAMPERVIOUS MATERIAL: AT WHAT DEPTH? i" ft- ✓ DOMESTIC WATER SUPLY: MUNICIP WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS P 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: ilcc 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. CP (,zMii- j TINA- NA o/ /7 t'Ct i,efv.-v ��S �iJ t ydt k ? SYSTEM TYPE: ❑ABSORPTION FIELD(WITH NO. 2 STONE) Total length ft. Each trench 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 isposal Ordinance. J codes(a.queensburv.net /le/ 3- VISIT OUR WEBSITE FOR MORE INFORMATION Signature of Person Responsible Date www.queensbury.net Septic Inspection Report Office No. (518) 761-8256 Date Ins.- ion • •- --,iv-• Queensbury Building &Code Enforcement Arrive: •-part: • B 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: TL 'E' IT NO.: LOCATION: 5- :(zE`t \)S\ I PECT ON: 9. —7jh— i 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 BUftT End Cap YN AS 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 - Foundation to absorption ft. Separation o ft. V E_C E\� �- A p BU 1�1J, ' Cr-- Conforms as •- ' of Plan N J"- Engineer Repo 'and As-B ' APY Y N ETU Maintenance Contract _Y_ N provided Location of System on Property: Front Re 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 Report 03 29 10.doc cat „ I. 19r2 -119 /vim< ,, bI - /- r ,� . I I /01 •r f y 4-wno �u � �,4 Trig T p��,.,uKO2 jib 1�� f- m - ftarM�k�crrv� �zl (-210A ___(-- /7. 71. c bLic, 7pfzi, ?yAr ,i9/"frt. ti .?"-A, -1 p 7 iv ( e-'i0 Septic Inspection Report 0 Office No. (518) 761-8256 Date Ins•.- ion r- - -i ' `)-S -mm t 3 Queensbury Building &Code Enforcement Arrive: - 7 • 4!•II=.art: "Effrefflr 742 Bay Rd., Queensbury, NY 12804 Inspector's Initia �� NAME: 9tli 0,,,y,tAl_. PERMIT NO.: - LOCATION: A1)6'1,4.- 1/ INSPECT ON: AM 13 RECHECK: Comments and/or diagram Soil Type a j Clay Type of Water: MunicipaleIl,Water .ice �4� Waterline separation n e ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A [150'to well required if NO] lam, Absorption Field: Total length Length of each trench (,,,---------2:;a Depth of trenches j� ft. Size of Stone Seepage Pits: Number ________ Size: x Stone Size: Piping Size Type Building to tank1.-)4A-k- t `-t u Tank to Distribution Box Lt i .,; \---u LyL‘2,T, �-). Distribution Box to Field / Pit Opening Sealed: N/Y N End CapY N Inlet/utlet Pipes & Baffles —. ,_ N Manholes 12"or less below grade ,V/ N [provide extension collar if Yes] N v Location / Separations Foundation to tank ft. ,A15- v Foundation to absor•tion ft. . ---,,----C1. ...) t' Separation of Pits / ft-.. v'r U Conforms as per Plot Plan �Y N/� Engineer Report and As-Built ^Y ✓fii ETU Maintenance Contract Y_ N provided Location of System on Property: 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 L:\Pam Whiting\2010\Building Codes Forms\Inspection Forrns\Septic Inspection Report`03 29 10.doc i • 0° 41 a 411k i : 111 /�- \ 1443 \Zs: i"# ' ....- i 41 11111*,/ i • i' I� • 41 • a 4,ei . • _. a � � - F mi / ./ 7,.... 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