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2009-165 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090165 Application Number. A20090165 Tax Map No: 523400-309-009-0001-009-000-0000 Permission is hereby granted to: MARK F REILLY For property located at: 46 OHIO 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: MARK F REILLY 46 OHIO Ave Septic Alteration Residential QUEENSBURY,NY 12804 Total value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2009-165 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,May 04,2010 (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 Towr, Queens D✓ib ay,May 04,2009 SIGNED BY T for the Town of Queensbury. Director of Building&Code Enforcement TOWN OF QUIEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20090165 Date Issued: Thursday, August 26, 2010 This is to certify that work requested to be done as shown by Permit Number P20090165 has been completed. Tax Map Number. 523400-309-009-0001-009-000-0000 Location: 46 OHIO Ave Owner. MARK F REILLY Applicant: MARK F REILLY This structure maybe occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY i Issuance of this Certificate of Compliance DOES NOT relieve the { 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&G a Enforcement Planning Board or Zoning Board of Appeals. -------------------------------------- --_--- E OFFICE USE ONLY TAX MAP NO. PERMIT NO. PERMIT FEE 01 2009 APPROVALS: ZONING TOWN CLERK '-- ------ ; QUEENSBU 1 _- -_-_ APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT; , A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT 0 REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: s INSTALLER: JZ �,(�ty� �l ADDRESS: ADDRESS: 3 20 X Z 2 PHONE NOS. 93 — /6 j, PHONE NOS. 7 oPs3 LOCATION OF INSTALLATION: ` . 0 r l i 0 Prue YEAR BUILT NO.OF X COMPUTATION= RESIDENCE INFORMATION: BEDROOMS = TOTAL DAILY FLOW 1980 or older X 150 gallon per bedroom = GARBAGE GRIND 3 INSTALLED? NEz3 1981 -1991 X 130 gallon per bedroom 1992-present X 110 gallon per bedroom = SPA OR HOT TUB INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At wh t.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 professional engineer or architect (unless installed in a Planning Board approved subdivision). TANK SIZE: ` 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. p SYSTEM TYPE: AABSORPTION FIELD (WITH NO. 2 STONE) Total length � ©J ft. Each trench X � ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ 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 (::4 IONS? CALL 761-8256 OR EMAIL Q nsbur Sanitary Sewage Disposal Ordinance. codes agueensburv.net WEBSITE FOR MORE INFORMATION d�p 9 www.aueensburv.net Signature of Person sponsible Date / Town of Queensbury - Community Development Office- 742 Bay Road, Queensbury, NY12804 1 , aCo Septic Inspection Report Office No. (518) 761-8256 Date Ins ctio st ceiv d: Queensbury Building &Code Enforcement Arrive: a part: arr� 742 Bay Rd., Queensbury, NY 12804 Inspector's Initi L NAME: PE IT — LOCATION: IN ECT ON: — -- RECHECK: Comments and/or diagram Soil T m/ Clay Type of Water: unici Well Water Wat aration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length -D ft. Length of each trench 0ft. Depth of trenches "L— ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size T Building to tank Tank to Distribution Box ` Distribution Box to Field Pit Sv Opening Sealed: Y N End Cap _ N Inlet/Outlet Pipes&Baffles Y N Location Separations .�< Foundation to tank ti 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 ar eft Si ht Side Middle Front Middle Rear System Use S us: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc y pus Q ocol a o,.cfrx3 �9