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2011-002 TOWN OFQ UEENSBURY Firm 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110002 Date Issued: Monday, June 04, 2012 This is to certify that work requested to be done as shown by Permit Number P20110002 has been completed. Tax Map Number: 523400-301-020-0002-001-000-0000 Location: PEGGY ANN Rd Owner: QUEEN VICTORIA GRANT Applicant: QUEEN VICTORIA GRANT This structure may be occupied as a: Septic Alteration Commercial 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, / °1 . Variance, or other issues and conditions as a result of approvals by the Director of Building&Code nforce ent Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY ifil°144 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20110002 Application Number. A20110002 Tax Map No: 523400-301-020-0002-001-000-0000 Permission is hereby granted to: QUEEN VICTORIA GRANT For property located at: PEGGY ANN 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: QUEEN VICTORIA GRANT HOMEOWNERS ASSOC. INC. C/O Septic Alteration Commercial MARGARET DR. BOX A Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency COOKS SEPTIC NY 12804-0000 Plans &Specifications 2011-002 septic alteration shared system - 70 & 72 Queen Mary Dr $75.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, January 10, 2012 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of Queens urs, onday;January 10, 2011 SIGNED BYE ,/ :: for the Town of Queensbury. Director of Building&Code Enforcement r r OFFICE USE ONLY 30 , zU ��- / ; TAX MAP NO. PERMIT NO. ILff VU�— PERMIT FEE •I APPROVALS: ZONING TOWN CLERK • • APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUS , E OBTAINED BEFORE ORK BEGIN PPLIC TION IS SUBJECT TO RFjVII {II BEFORE ISSUANCE OF A VA D, PERMIT. OWNER: bee(71 V re/4,�' INSTALLER: ( o/$ ----- v/ i U ADDRESS: (( i(dl 47 -o 72 ADDRESS: / C hL/ /It r /q. PHONE NOS. PHONE NOS. 0/ ,_cCS/ LOCATION OF INSTALLATION: !!! RESIDENCE INFORMATION: YEAR BUILT NO. OF X COMPUTATION= = TOTAL DAILY FLOW BEDROOMS GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand f Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At w at depth? ✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is per minute per inch. (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 profe sionilAngineer or architect (unless installed in a Planning Board approved subdivision). TANK SIZE: 0/4(1 GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size the s ptic t r each garbage grinder, spa or whirlpool tub. J 0 p1 Xi5, ')/(4,-,h SYSTEM TYPE: / / El ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X Lam! SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? 12- Size? ry 9 ❑ ALTERNATIVE SYSTEM Bed or other type? ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? ii 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 -sloe 'y these and all requirements oft e Town of QUESTIONS? CALL 761-8256 OR EMAIL Quee -bu y Sa itary Sew..= D rsal 6.-:in ce. codes@dueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION www.queensbury-net Si• - .. f - . Person •esp i nsi s le ate • 1..,21-3- Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804 B 5-LGL 6/06 Septic Inspection Repo Office No. (518) 761-8256 Date Ins.- ion r; •- -• Queensbury Building&Code Enforcement Arrive: = - -- 5P/apart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspectois.(1 NAME: ♦C..�o�2.a� /rr -- �l)E ��"' • NO.: `� 0o-7-- LOCATION: oZ.iLOCATION: 7t 77- ex5 hR\ SPECT ON: (a. L_1 RECHECK: s,S PT‘C.- iltL-1� - tttJ Comments and/or diagram Soil Type: Sand/ Loam I Clay Type of Water: Municipal/Well Water Waterline separation distance ft. V \ E ) D kc* C-004 Well separation distance ft. Other wells: ft. -� ?-ePt_fte e_D D-2006 Well Casing Length 50'+/- Y N N/A [150'to well required if NO1 -�- 1J ��� 0. Absorption Field: Total length ft. kz `LL±) �C`�Cii6N-cd 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 Location/Separations ^CFouFoundation to tank ft. •5C- Foundation ndation 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 o Property: Front ear Left Si Right Side Middle Front Middle Rear m Use S tus: Approv Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved LAPam Whiting\2010\Building Codes Forms on Forms c Inspection Report_03 29 10.doc iitv.5/ C9(ibt Slat-US Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804, Ins or's NAME: OfeeK. iu 1 bra 1—COZ LOCATION: -17‘s , V t 1, 1/1 • INSPECT ON: RECHECK: c©mse/Inc Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. e),,of're_01 Well separation distance ft. Other wells: ft. f f o Well Casing Length 50'+/- Y �._.N, N/A / Absorption Field: Total length ft. Length of each trench ft. 11 0 .510P—en O & Depth of trenches ft. Size of Stone Seepage Pits: Number Qr e . 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 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 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 Last revised 06/18/07 L:\Buildlng&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc II: •-I \M _ f. r _•- r r' IS. t; ,6, 11 \ittes:t.I. _ 0 161-0" (T YP ALL SIZES; i 0 ,1 1 411PVC—SDR 26 t 2A2 DIST. II 2x2 DIST BOX BY80X FORT MILLER 111 { ti i ...--- 611 PVC—SDR 26 I f 1 '' 1 -4 6PVC-SDR 26 ' _L. • 1000 GAL. SEPTIC ..4.-----TANK BY FORT MILLER 1250 GAL 1,1 jr--------BY FOR T t Y . 11 611PVC—SDR 26 611 PVC—SDR 26 s' • DRYWELL PLAN DRYWELL PLAN `4- 2-UNITS • t 4-UNITS Not Tc Scale Not To Scale I CD ✓f ® Co Ix Ivoo.95' �.`'• sot.Ys � ,'..�,� � � ; •;� �` /�. 'f \g �CsyU + tA?0 G.SEP IV Ic lb GO T,r 4 .5 d Y � 399..25 .:399.83