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2009-424 I TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 EIxTI F I f% a.�TE OF C 0 M P L I-A-N Pemiit Number. P20090424 Date Issued: Wednesday, September 30, 2009 This is to certify that work requested to be done as shown by Permit Number P20090424 has been completed. Tax Map Number. 523400-309-007-0001-041-000-0000 Location: 26 HOLDEN Ave Owner. WILLIAM & DEBRA ALLEN Applicant: WILLIAM & DEBRA ALLEN 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,V Variance, or other issues and conditions as a result of approvals by the Director of Building&Code E ement 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: P20090424 Application Number. A20090424 Tax Map No: 523400-3 09-007-0001-04 1-000-0000 Permission is hereby granted to: WILLIAM&DEBRA ALLEN For property located at: 26 HOLDEN 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: WILLIAM &DEBRA ALLEN 26 HOLDEN Ave Septic Alteration Residential QUEENSBURY,NY 12804-0000 Total value Contractor or Builders Name/Address Electrical Inspection Agency DAVE SUMMERS EXCAVATING 848-6685 Ave NY 12804-0000 Plans&Specifications 2009-424 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 08,2010 (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 th Rhvf Que ` btu; fZesday, September 08,2009 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 BUILDING PERMIT Permit Number: P20090424 Application Number. A20090424 Tax Map No: 523400-309-007-0001-041-000-0000 Permission is hereby granted to: WILLIAM&DEBRA ALLEN For properly located at: 26 HOLDEN 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: WILLIAM &DEBRA ALLEN 26 HOLDEN Ave Septic Alteration Residential QUEENSBURY,NY 12804-0000 Total Value Contractor or Builder's Name 1 Address Electrical Inspection Agency DAVE SUMMERS EXCAVATING 848-6685 Ave NY 12804-0000 Plans&Specifications 2009-424 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 08,2010 (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 Tofu of ensb 's September 08, 2009 SIGNED BY `' for the Town of Queensbury. Director of Building&Code Enforcement ---- ------- ------- OFFICE USE ONLY- TAX MAP NO.,'-:�D.7-1- PERMIT NO. Oe '-'I'/-'!/ERMIT FEE APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM-Ox-Aw T. A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO RI-EYIE-W-BEFORE ISSUANCE OF A VALID PERMIT. OWNER: lk A %'-AtA Bkl-Ej� INSTALLER: G ADDRESS: 2A Q 14-ALDEN� [WF- ADDRESS: PHONE NOS. -797 PHONE NOS. LOCATION OF INSTALLATION: Z-(U NO.OF RESIDENCE INFORMATION. YEAR BUILT BEDROOMS x COMPUTATION= TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = �3C)C) L 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 Loam- Clay- Other ✓ GROUNDWATER: At what depth? Z- ✓ BEDROCMMPERVIOUS MATERIAL At what depth? ✓ DOMESTIC WATER SUPLY: Municipal-- Well (If well: Water supply from any septic system absorption is t.) ✓ 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: C�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: I olptu"F'A� [Y/ABSORPTION FIELD (WiTI -0 88-1--NE) Total length QCft. Each trench X ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ ALTERNATIVE SYSTEM Bed or other type? 0 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 misreDrP.qant-1*-^- failure to make a material fact or circumstance known by or on hohnif -1 1 D O i Septic Inspection Report Office No. (518) 761-8256 Date InspectionJre Queensbury Building &Code Enforcement Arrive: ��art: r am m 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: W 11._U A M TON LOCATION: -LQ kA�E�� J RECHECK: Comments and/or diagram Soil T Sand Loam/ Clay Type of Water: M-unicipaD Well Water Waterline separation distance o V. *J P Well separation distance ft. Other wells: ft. Well Casing Length 50' + - Y N_N/A Absorption Field: Total length I zjo ft. EijJ�tt ►RPiT� Length of each trench ft. Depth of trenches ft. Size of Stone ►J Seepage Pits: Number Size: x Stone Size: C Piping Size Type Building to tank [ `Y3oDJAVUE1 E tl E rcS� Tank to Distribution Box Distribution Box to Field / Pit Opening Sealed: N Dz\ y End Cap N Inlet/Outlet Pipes&Baffles N Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot P N Engineer Report a -B i Y N Location of System on Property: Front Rear Left Side Right Side Middle Front fiddle Rear 5ystem tus: 7 Approved Partial Appro ed and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc Septic Inspection Report Office No. (518) 761-8256 Date Ins ion T receiv Queensbury Building &Code Enforcement Arrive: a m a 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: 0%1-t k\ >r t. ERMIT NO.: LOCATION: 'j. a �--t �� ta„1� INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand Loam/ Clay Type of Water: Municipal Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - 1 Y N_N/A / Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. <ZV� Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field I Pit Opening Sealed: Y N End Cap Y N InletjOutlet 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 uswmu t 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-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc c ` O. O O d 'c Z L.. .y O. O U N N 2 c N v C p O > m N C C N N N W m o a '> w O ` m a u) ¢ 'S n U W N W m d N 03 46,y f ri 9 k $ i y Vf � J i 41 "Al If C Q N ( N Y � O 'F E QI } t� k K; 1 W J d Lis '�a�2,; � �''r •� '� � cr- 63 u a ...• m { x ❑, N p ,a • F`� v, A, m d i�J• ........_�_..___xu �m1Yts�F�'aa"'�.:o��aYn�+ � N 4„,/ •