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2008-553 TOWN OF QUE E NSB URY 10 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20080553 Date Issued: Tuesday, October 21, 2008 This is to certify that work requested to be done as shown by Permit Number P20080553 has been completed. Tax Map Number. 523400-278-000-0002-003-000-0000 Location: 1324 BAY Rd Owner. MARK SCHACHNER Applicant: MARK SCHACHNER 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 cl„..1 ,e. / �` r 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. TOWN OF QUEENSBURY Ole•c$1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20080553 Application Number. A20080553 Tax Map No: 523400-278-000-0002-003-000-0000 Permission is hereby granted to: MARK SCHACHNER For property located at: 1324 BAY 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: MARK SCHACHNER 1324 BAY Rd Septic Alteration Residential LAKE GEORGE, NY 12845 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2008-553 septic alteration $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, October 21,2009 (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 Towrib€Queei sbury; Tuesday, October 21,2008 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement T' OFFICE USE ONLY r TAX MAP NO. " " • PERMIT NO. (3ce_______ PERMIT FEE L-9 , APPROVALS: ZONING •• TOWN CLERK •• ; ; • APPLICATION FORSEPTIC • DI SPQSAL SYSTEM PERMIT. ' • ' A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.PERMIT, + APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID OWNER:�(n 1 Cl /� �� L INSTALLER: z r r , ADDRESS: ADDRESS: — C� /' 6k..a PHONE NOS._ (� PHONE NOS. LOCATION OF INSTALLATION: YEAR BUILT NO.OF RESIDENCE INFORMATION:BEDROOMS X COMPUTATIONa = TOTAL DAILY FLOW 1980 or older X 150 gallon per bedroom _ GARBAGE GRINDER -1µ INSINSTALLED?991 »...... 1981 X 130 gallon per bedroom , = I 1992-presentµ X 110 gallon per bedroom 1 _ ! SPA OR HOT TUB INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING'►L STEEP SLOPE %SLOPE SOIL NATURE: SANDY_ LOAM CLAY OTHER ✓ GR__,�0_UNDWATER: AT WHAT DEPTH?4/± BE WHAT DEPTH? DROCK/IMPERVI MATERIAL: AT ✓ DQMESTIC WATER St IPI Y: MUNICIPAL WELLAV (IF WELL:WATER SUPPLY FROM AN S P IC-SYSTEM ABSORPTION IS 4! Tt ✓ PERCOLATION TEST: RATE IS ' MIINUTE PER INCH ( COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHIT CT)TEST TO BE 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). Add 250 gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub. ✓ EPTI TAN • GALLON (MIN. SIZE IS 1,000 GAL.) TILD: EACH THE NCH.SSC FT. ✓ TOTAL SYSTEM LENGT G, FT. SEEPAGE PIT(S): HOW MANY? ✓ SIZE OF EACH FT. X FT. ✓ SIZE OF STONE TO B us # /DEPTH OR THICKNESS ✓ BED SYSTEM SIZE: ✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE ✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH ✓ GALLONS./TOTAL CAPACITY.•---___GAL. 11 NOTE: ALARM S...........................................................CTRICAL WORK MUST APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST p INSPECTED.... Y A TOWN 1........... .......:.....», ROVIDED. 1 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 781.8256 OR EMAIL Queensbu nitary Sewage Disposal Ordinance. codesaueenab ry net k _ VISIT OUR WEBSITE FOR MORE INFORMATION W W W.QUe8,11UrV.rtet nature of Person Responsible Date $t, Town of Queensbury • Community Development Office ■ 742 Bay Road, Queensbury, NY 12804 • 41,..„,, I P`1`- Septic Inspection Report Office No. (518) 761-8256 Date Inspection r-• ,- ed: 1 C7/ L 7 0 i Queensbury Building &Code Enforcement Arrive: 1.f11i r repart: ,'-tp an 742 Bay Rd., Queensbury, NY 12804 Inspector's Initial• �1,. NAME: Ea< PE' IT NO.: 6 .� LOCATION: I 1k ( V-2,„ � IN.• CT ON: RECHECK: Comments and/or diagram Soil Typeo ^ . Type of Water: ->� - Waterline separatio .isr: ce ft. Well separation distance '©'Q ft. Other wells: ft.' Well Casing Length 50' + / - Y N NSA Absorption Field: Total length .yam ft. Length of each trench WQ cO ft. Depth of trenches y ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank 1-rIci. - p q' c..vk 146 Tank to Distribution Box \.- bc.eo-t0 Distribution Box to Field/ Pit �-j‘ 9JC 'c; o Q�� Opening Sealed: Y N End Cap ^N Inlet/Outlet Pipes&Baffles _Y N Location/ Separations Foundation to tank \C ft. Foundation to absorption 1"1ft. Separation of Pits ft. Conforms as per Plot • . _N Engineer Report and -Bui _Y N Location of System on Property: Front -ar Left Side •ight Si. Middle Front Middle Rear System Use S‘,Itt. 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 • } pS 4t, � r 4 [---- . • . . ., . . , /66 c.....,.:, ......, /In CA r k . .., ... _ . .. , ....... (265 -2 , __.1 1 9 :::„, ,, . . .. , /*\ I .„ ., c.„.„ p 0 II"(v LA , .. ....„..,„s„......,..01,21 • 0 , • ,N, () 1 \0 TOWN OF QuEpsis' B _56 Reviewed By. /e.A r in t % co Date: , .• ',trio! •' . 101-1-