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2014-612 9.411.1" TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20140612 Date Issued: Friday, December 05, 2014 This is to certify that work requested to be done as shown by Permit Number P20140612 has been completed. Tax Map Number: 523400-308-018-0002-008-000-0000 Location: 18 REVERE Rd Owner: MICHAEL & KATHANNE ROBINSON Applicant: MICHAEL & KATHANNE ROBINSON 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, GGGwwwii���"' 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 ` r- 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20140612 Application Number: A20140612 Tax Map No: 523400-308-018-0002-008-000-0000 Permission is hereby granted to: MICHAEL&KATHANNE ROBINSON For property located at: 18 REVERE 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: MICHAEL& KATHANNE ROBINS( 18 REVERE Rd Septic Alteration Residential QUEENSBURY,NY 12804-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans& Specifications 2014-612 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 26,2015 (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 ftie sbu Q )01 /j W��ovember 26,2014 SIGNED BY for the Town of Queensbury. Director of Building& Code Enforcement -r, I. U 11111 office use oma- --- `''1 Town of Queensbury Building & Codes ivec oq 25 2©14 \v SEPTIC DISPOSAL PERMIT Tex 10: , O .4'g=Via,-� a A permit must be obtained before beginning constmdion Phmft F P " - ✓'o'f'f Permit Fee:E0 /� , iAp iicss� �•1 / Applicant /�iGArakY £ ' 'So.• InstaferdBuldar ,J�•vi,4-a„ Jen,,,t JerviCe Address: /,,�F/� � RQut//Qe Address .�r . ,tL 22 !!` ergi/.7`.p� A -- 4-rk,9 ,ca.M- /tY /Z6+c/ Phone: Phone 7707-Jas/�2 Owner. -fie--C Location of Installation /,F /tom lent c Address: Phone Contact Person for Building&Code Compliance: (Tea r, c b''� Day Pone;77i 3744 Residence information: U Year Built ftof Bedrooms x Gallons per bedroom =Total Daly Flow 1980 or older x 150 = Garbage Grinder installed? .✓a 1981-1991 DC3- x 130 = 110 Spm or Hot Tub lretafed? n 1992-Present x 110 = Parcel Information: Topography D Flat Rolling _Steep Slope _%Slope Soil Nature (Sand _Loam _Clay _Other Groundwater - At what depth? NA Bedrolls/Impervious Material qt vdtatdepth? X4 Domestic Water Supply _ix_Municipal _Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate)-s per minute per loon(Test to be completed bya licensedrofessional p engineer or ardultect) Proposed System for New Construction: All individual sewage dmposal systems must be designed by a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision). Tank size ,./CPV gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub System Type: Absorption Reid(with#2 stone) Total length Zoo Ti Each trench .S'-O x li Seepage Pit(S)(with#3 stone) How many? Size? Alternative System Bed or other type? Holding Tank System Total required capacity? Tank size? #of tanks? NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Etegdcal form on Town website;2)Effective as of March 23,2006 Septic System As Built Plot Plan: The Building Department will no longer allow systems to be covered unto such time as an As-Built Piot Plan is received and approved by the Building Inspector. The Installed system must match the septic system layout on file. There will be no exceptions. 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,shell be void 11 have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. �� Print Name: s b"e mal P Date: � 2 -/Y Signature: q Date //'3r- /9 Town of Queensbury Building&Codes Septic dish Permit 518-781-8258 C—Ajt,r-f,e Septic Inspection ���' 1 , pt A —�'--- Office No. (518) 761-8256 Dam Ins• •n r�=:,,11� - .: /� _ ,_� Queensbury Building&Code Enforcement Arrive: r r, r.-••rt: n . /• ` d 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials. Are` NAME: t! flokiSo T NO.: -.av4- / LOCATION: I'h:• ON: RECHECK: lAt - Wf Comments and/or diaaranl Soil T is- ••m/Clay Type of War Mupidpa Well Water yy"" �/� Waterline separacon , , .nce ft. !- Sed J C V S Well separation distance ft. Other wells: ft. 7 - 37(, d Well Casing Length 50'+/- _Y N_N/A [150'to well required if NO] Absorption Field: Total length _t)0 ft. Length of each trench (5:345-b ft. Depth of trenches 2^P/z ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank EiCi/)V 4" Tank to Distribution Box lir t /DO R 015 Distribution Box to field/ Pit L t1 •,' 4"".1R3�i ? t.& Openi • Sealed: ` N End Cap 17 N Inlet/Outlet Pipes&Baffles Manholes 12'or less below grade _Y [provide extension collar if Yes] v Y N Location/Separations Foundation to tank 12. . 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 _Y_N provided Location of System on Property: Front R r Left Side Right Side Middle Fro__ ���:a!__r. em U S s: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting 12010\auilding Codes Forms\Inspecbon Fonrs\5eptic Inspection Report03 29 10.doc /n rch ad ,Pati,„s ore. SEPTIT PLAN HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES,WELLS,TREES, FENCES, ETC SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY TOWN OF QU Il THONTHISDIAGM�BUILDING & Oilgin SATE Reviewed B •Date: �L�'1 t .2 , ir py F/oudc - 4.0441 DtvC rip .,. D a Z5 '- 3 Ce 0 1^Cd � Os / ? /Qe reRe A f