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2013-237 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE CJF COMPLI-ANCE Permit Number: P20130237 Date Issued: Thursday, June 06, 2013 This is to certify that work requested to be done as shown by Permit Number P20130237 has been completed. Tax Map Number: 523400-290-000-0001-044-000-0000 Location: 267 CHESTNUT RIDGE Rd Owner: LARRY ADAM GRAY Applicant: LARRY ADAM GRAY 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, W2k7 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 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20130237 Application Number: A20130237 Tax Map No: 523400-290-000-0001-044-000-0000 Permission is hereby granted to: LARRY ADAM GRAY For property located at: 267 CHESTNUT RIDGE Rd 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: LARRY ADAM GRAY Septic Alteration Residential SARAH ELIZABETH BOONE 267 CHESTNUT RIDGE Rd 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 2013-237 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,June 05,2014 (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 o uee bury; �ed s ,June 05,2013 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement ' ` Community �N��UKX . = Town of Queensbury ^ 742 Bay Road ^ Queensbury, New York ^12804 Office Use Only TAX MAP NO. Xq 0 t PERMIT NO. PERMIT FEE "-y 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: L INSTALLER: lis, �' e k. J - Pf. PHONE NOS. PHONE NOS. LOCATION OF INSTALLATION YEAR BUILT NO.OF x COMPUTATION TOTAL DAILY FLOW RESIDENCE INFORMATION — BEDROOMS (Gallons per bedroom) GARBAGE 1980 or older x 150 a INSTALLED? 1981-1991 x 130 SPA 0RHOT 1992-present x 110 INSTALLED? PARCEL INFORMATION: � TOUPOGRAPH FLAT ROI III|N� SLOPE %SLOPE V SOIL.NATURE: SAND LOAM-j� CLAY OTME ' + ^ xTxvo*TosPTnv_|iy..�__ / *TxvM^T ' ^ MUNICIPAL LL_lL(if well:water supply from any septic system absorption iu v' RATE IS ERMUNUTEPER INCH(npU (Test tobecompleted byulicensed 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 ina Planning Board approved subdiviokm). TANK SIZE: GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa orwhirlpool tub. SYSTEM TYPE- dABSORPTION FIELD(WITH NO.2 STONE) Total length2D-C3—ft. Each trench x •SEEPAGE PIT(S)(WITH NO.3 STONE) Howmany?.- VA Size? •ALTERNATIVE SYSTEM Bedor other type? •HOLDING TANK SYSTEM Total required capacity? Tanksize? fvft Numberoftanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL , MUST BEINSPECTED BY&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 isbased upon orisgranted hnreliance upon enymoteha|misrepresentation orfai|unm1omakwamateho|fodor circumstance known byoronbehalf ofonapplicant,shall bovoW. |have read the regulations with respect to this application*and agree to abide bythese and all requirements ofthe Town cfQueensbury NYS-Real Property System Subject Property Inventory Summary RPS030N04/L001 County of Warren For Current Year File 2013 Date: 5/30/2013 Town of Queensbury Parcel ID: 290.-1-44 Sheet 1 of 1 SWIS Code-523400 Active Parcel Information - ---- - - -- Parcel Land Size - - - File Maintenance Info Curr Owner: Gray LarrryA Acct#: Front: 0.00 Acres: 0.67 Created: 11/20/1984 Location: 267 Chestnut Ridge Rd School Cd: 523402 Queensbury Un.fr.: Depth: 0.00 Sq Ft: 0 Modified: 05/01/2013 03:02 PM Queensbury, NY 12804 Roll Sect: 1 Taxable RS/S: Grid Coordinates - By: Batch FM by teri Prop Class: 210 1 Family Res East. 728825 North 1652937 Folder: ASSESSMENT Site Characteristics -------- - -Site No: 1 Nbad Cd: 106 Rt9L,Eside,Sunr Site Desire: 2 Typical DC Entry Type: 1 Inter inspec Economic Obs: 0 Site Type: R Residential Sewer Type: 2 Private Nbad Type: 2 Suburban Zoning Cd: MDR Mod Density Re:Data Mailer: No Prop Class: 210 1 Family Res Water Supply: 2 Private Nbad Rating: 2 Average Last Phy Insp: 06/14/2012 Route No: Utilities: 3 Electric Road Type: 3 Improved Reappraisal: 09/13/2004 -- ---- - — -------------------------- Residential Building Information - — ---------------------- - - ------ --------- - -- - -------- -------- -- -- ---- Bldg Style: 01 Ranch No.Bath: 2 Fuel Type: 4 Oil Grade Adjust: 0 Area in Sq.Ft. No.Stories: 1.0 No.Half: 0 Central Air: Yes Pct Good: 0 1stStory: 1,296 FinBsmnt: 0 Ext Wall Mtrl: 01 Wood Bath Qual: 3 Normal Bsmt Type: 4 Full Func Obs: 0 2nd Story: 0 Unfin 1/2: 0 Act Yr Bit: 1958 No.Bdrms: 2 Bsmt Gar Cap: 2 Addl Story: 0 Unfin 3/4: 0 Eff Yr Bit: 1980 No.Rooms: 6 Overall Cond: 3 Normal 1/2 Story: 0 Unfin Rm: 0 Yr Remodel: No.Fireplcs: 0 Ext Cond: 3 Normal 3/4 Story: 0 Unfin Ovr Gar: 0 No.Kitchen: 1 Fireplc Type: Int Cond: 3 Normal Over Garage: 0 SFLA: 1,296 Kitchen Qual: 3 Normal Heat Type: 2 Hot air Constr Grade: C Average Fin Attic: 0 Fin Rec Rm: 972 Land Breakdowns Land Soil Wtrfrt Depth Infl Infl Infl Infl Land Unit Dim Type Front Depth Acres Sq Ft Rating Type Factor Pct Cd 1 Cd 2 Cd 3 Value Price Code 01 Primary 119.00 246.00 0.00 0 0 0 26150 219.748 Additional Improvements Structure Measure SQFT Overall Act Eff Yr Pct Func Sry Unit Bid Bid Code Code Diml Dim2 MISC Qty Grd Cond Yr Built Gd Obs Life RCN RCNLD No. No. Sec RP1 Porch,Open Dimension 6.00 4.00 .00 1.00 C Norm 1958 0 0 0 384 261 0 0 �t V Septic Inspection Report / Office No. (518) 761-8256 Date Inspection request received: C� Queensbury Building &Code Enforcement Arrive: am/pm Depart: am pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: j PERMIT NO.: 11 z -5) LOCATION: 'e S T lur� r .kf�-tINSPECT ON: RECHECK: Comments and/or diagram Soil T / Cla Type of Water: Municipal rACLET Waterline separation distance Well separation distance 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: Stone Size: Piping Size Type Building to tank A Lk Tank to Distribution Box " ::S) Distribution Box to Field Pit `r Opening Sealed: N End Ca _ N Inlet/Outlet Pipes&Baffles N Manholes 12"or less below grade _N [provide extension collar if Yes � N Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per PloLylan _ _N Engineer Report an As,ByflP Y N ETU Maintenance Contract Y_N provided Location of System on Property: Front ear Left Side Right Side Middle Front Middle Rear System Use Statu 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 2910.doc fl1 o��a .J IVIL Lu r( I Gff- j vljo� CON Reviewed BY*- SEPTIC PLOT PLAN | HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES,WELLS TREES,FENCES ETC SHOVM PS DOCUMENT I HAVE PERSONALLY \_ ME- UR OMDISTANCE SET FORTH ON THIS DIAGRAM. 7jr