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2009-187 TOWN OF QUEENSBURY (2t 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090187 Application Number. A20090187 Tax Map No: 523400-302-005-0001-086-000-0000 Permission is hereby granted to: HARRY R BAKER For property located at: 19 OLDAVIATION 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: HARRY R BAKER 19 OLD AVIATION Rd Septic Alteration Residential QUEENSBURY,NY 12804-0000 Total value Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans &Specifications 2009-187 SEPTIC ALTERATION RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,May 12, 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 Town of Qu nsbury-, / uesday, May 12, 2009 f SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement 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. P20090187 Date Issued: Friday, May 22, 2009 This is to certify that work regnested to be done as shown by Permit Number P20090187 has been cc r:ple*ed. Tax Map Number. 523400-302-005-0001-086-000-0000 Location: 19 OLD AVIATION Rd Owner. HARRY R BAKER Applicant: HARRY R BAKER This structure may be occupied as a: Septic Alteration Residential By Oder of Town Board TOWN OF QUEENSBURY t,�.j 4 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&Code Enforcement Planning Board or Zoning Board of Appeals. %_ _______^ OFFICE USE 0 _Y__"_.___"_______"______ � �_�_�"�_�,�_ r " — l—� �NO. r �Q PERMIT NO. U PERMIT FEE , MAY 0 7 2009 APPROVALS: ZONING TOWN CLERK ', , ' _ ,WNOFQUEENSBUR4 " Eit1nni G-&CO'DES-____. APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION Is SUBJEC 0 REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: 2 �- , INSTALLER: � l� Lo tZi2 �Ce2 ADDRESS: 2 ` �(N �qc I4 /2p ADDRESS: PHONE NOS. 2- G -`' PHONE Nos. LOCATION OF INSTALLATION: ( / C11.6J A i g-� I yN NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION- TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = J c? INSTALLED? kQ- 1981 -1991 X 130 gallon per bedroom SPA OR HOT TUB 1992-present X 1 110 gallon per bedroom = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand ✓ Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At what epth? ✓ 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: 1 000 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. SYSTEM TYPE: ABSORPTION FIELD (WITH NO. 2 STONE) Total length t. Each trench 2 X �Z ❑ 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 QUESTIONS? CALL 761-8256 OR EMAIL Queensbury Sanitary Sewage Disposal Ordinance. codeseaueensl)ury.net VISIT OUR WEBSITE FOR MORE INFORMATION © www.gueensburv.net Slgnature of erson Responsible Date QTown of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804 (11030 ) /0 -/Z- 7vns Septic Inspection Report Office No. (518) 761-8256 Date Inspecti n,request received: Queensbury Building &Code Enforcement Arrive: am/pq_L part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspecto 's Inl 'als:�_ NAME: PERMIT NO.: LOCATION: t.�,., INSPECT ON: _ -* RECHECK: Comments and/or diagram Soil Ty Loam / Clay Type of Water: unici / Well Water Water' oration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length ft. Length of each trench ft. Depth of trenches Size of Stone Jlf 2— Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank 4✓G Tank to Distribution Box re Distribution Box to Field Pit sl Opening Sealed: N End Cap _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 Sy n Pro erty: Front Re Left Side Right Side Middle Front Middle Rear u 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 SOWN OF QUEENSBURYBUILDIG DEPARTMENT �- N -- Based on our limited exam;nation, compliance with our comments shall not be construed as indicating the plans and spedcatlons are in full compliance with the Building Codes of 1. a New York State. 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