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2009-583 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 CE IF ICA`I'E 0- F C 0 M P L I-A-N- E f Permit Number. P20090583 Date Issued: Monday, December 07, 2009 This is to certify that work requested to be done as shown by Permit Number P20090583 has been completed. Tax Map Number: 523400-309-011-0002-008-000-0000 Location: 2 ALLEN Ln Owner. BRUCE & JOYCE BURKE Applicant: BRUCE & JOYCE BURKE This structure maybe occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the , d owner of the responsibility for compliance with Site Plan property P ty P 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 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090583 Application Number. A20090583 Tax Map No: 523400-309-011-0002-008-000-0000 Permission is hereby granted to: BRUCE &JOYCE BURKE For property located at: 2 ALLEN Ln 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. Tyke of Construction Value Owner Address: BRUCE &JOYCE BURKE Septic Alteration Residential BOX 512 GLENS FALLS,NY 12801 Total value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2009-583 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,December 01, 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 To Queely' ry; u d ecember 01, 2009 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement %_________________________' OFFICE USE ONLY- -____ _________; JJ 1 o TAX MAP NO. ? PERMIT NO. L 1PERMIT F , ✓' 10 APPROVALS: ZONING TOWN CLERK )t A -----------___-------_-------------_______________________________! APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERM1T:--- - _' A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. 1 � l L ccqq OWNER:' �CiC �� Jo-VC INSTALLER: �.��6e.r Qr cSCJLi� X�Gi) �cJ ADDRESS: l"'t LL e �1 �Iq A) ADDRESS: a� W 6(r /L S ��� San �u�C.t Al ; u ePN S k A p N YP FOT PHONE NOS. �LI�' d c� t4 PHONE NOS. G-19) 3 at S <-R I1 n LOCATION OF INSTALLATION: N74 9-0 a) NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED? V 0 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom 3 "3 Q INSTALLED? C) PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At what 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. SYSTEM TYPE: ❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length 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. Septic Inspection Rep Office No. (518) 761-8256 Date Inspection reque ei d: Queensbury Building &Code Enforcement Arrive: C�l�am epart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: P NO.: _ LOCATION: LLB S CT ON: -- RECHECK: Comments and/or diagram Soil T : Sand Loam/ Clay Type of Water: Municipal Well Water Waterline separation 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. De th 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 O nin Sealed: Y N End Ca Y N Inlet/Outlet Pi s&Baffles Y N Location Separations Foundation to tank ft. Foundation to absorption Separation of Pits ft. Conforms as per PI o N Engineer Report d As-Built Y N Location of System on Property: Front Re Left Side Right Side Middle Front Middle Rear S m s s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 U\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc I E J Septic Inspection Report Office No. (518) 761-8256 Date Inspection r r e' Queensbury Building &Code Enforcement Arrive: pm part: a m 742 Bay Rd., Queensbury, NY 12804 Inspector's Initi s: NAME: _ Y' P R IT NO.: LOCATION: ECT ON: RECHECK: Comments and/or diagram Soil T Sa L / Clay- TyDe of Wa r: M Well Water terline ration distance ft. separation distance ft. Other wells: ft. Well Casing Length 50' + - Y N NJA Absor tion Field: Total length_ ft. Length of each trench ft. Depth of trenches Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size T e Building to tank �t �k Tank to Distribution Box JA« V 1`Q-- Distribution Box to Field/ Pit Ak , r— Opening Sealed: W, N End Ca N Inle Outlet Pipes&Baffles Y N Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits /� t � �- '�1 Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of System on Property: ._.. ----- _ Front ear Left Side "`Right Side Middle Fr —Middle Rear 5ystem Use Status• pproved 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 t—r t I ij -� 4) o D 4) RS ^ — 5 M 14, 1 a — —— — — —_ , i : I -- _ ... _.------ F -- a ..-- -- — — — — -- I v —i—— 4 i i n I � - :� 73 i i -..__.--- QN- i.