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2008-605 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. P20080605 Date Issued: Friday, November 14, 2008 This is to certify that work requested to be done as shown by Permit Number P20080605 has been completed. Tax Map Number. 523400-302-014-0001-018-000-0000 Location: 13 PERSHING Rd Owner. RANDY & EILEEN STRONG ,Applicant: RANDY & EILEEN STRONG 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 /f 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 nfoncement 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: P20080605 Application Number. A20080605 Tax Map No: 523400-302-014-0001-018-000-0000 Permission is hereby granted to: RANDY & EILEEN STRONG For property located at: 13 PERSHING 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 QueensburyZoning Ordinance. Type of Construction Value Owner Address: RANDY& EILEEN STRONG 13 PERSHING Rd Septic Alteration Residential QUEENSBURY,NY 12804 Total value Contractor or Builders Name/Address Electrical Inspection Agency Plans &Specifications 2008-605 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,November 13,2009 (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 of Que b ay,November 13,2008 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement ._- -OFFICE USE ON_Y............... ,_ %_ lo TAX MAP NO. PERMIT NO. PERMIT EE lo o / , 0 , APPROVALS: ZONING TOWN CLERKtr; 0%; _ I � k o ...........-----------.............................................................-'-:�- 08..--11...1........ APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. I OWNER: r l L C t INSTALLER: „t�e ADDRESS: ADDRESS: ' (� _6 � t-`> a _ PHONE NOS._ ! �— C �f t PHONE NOS. t 1 S -�ie7 8©2Z LOCATION OF INSTALLATION: NO.OF RESIDENCE INFORMATION: YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW BEDROOMS GARBAGE GRIND R 1980 or older X 150 gallon per bedroom = �S Zj INSTALLED? 1981 -1991 IjX 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? ✓ 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 minutes per inch [MPI] (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). ANK SIZE: IGALLON (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 ST E) Total length ft. Each trench X ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) ow many? Size? ❑ ALTERNATIVE SYSTEM Bed or other type. ❑ HOLDING TANK SYSTEM Total required capacity. Tank size? mber of tanks? .::NOTE:. ALARM:..:.:Y.:.:.TEM AND _..:.................:.....:........:....:..::....::._..:.::_....:.._.::. ..............:...:..::.:.P_...:.::::...:.:_...:.._. ..::_....:.......:...: SYSTEM D SS CIATED ELECTRICAL WORK MU ,INS CTED BY WN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIS R 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. codes@--- ensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION www.aueensbury.net Sijnatijrelof Person Responsible Date :- Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804 B 5-LGL 6/06 i t i d p G � i , ( d j ------------------- 411 7 . B, ewed r 3 Septic Inspection Report Office No. (518) 761-8256 Date Inspectio request received: Queensbury Building &Code Enforcement Arrive: am/p e am/pm 742 Bay Rd., Queen ury, NY 12804 Inspector's Initials: part: NAME: /3�1d v A PERMIT NO.: LOCATION: C-- INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam Clay Type of Water: Municipal/ Well Water Waterlinene separation ration distance ft. Well separation distance Other wells: Well Casing Length 50' + - Y N N/A � 1 Absorption Field: Total length ft. Length of each trench ft. Depth 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 Opening Sealed: Y 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 System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: 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 e-7 Septic Inspection Report Office No. (518) 761-8256 Date Ins cti request received: Queensbury Building &Code Enforcement Arrive: • I am/ ,Depart: am/pm rY Pe 742 Bay Rd., Queensbu , NY 12804 Inspector' Is: C-''' - � NAME: J V PERMIT NO.: LOCATION: 1 t1s? INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay X'7 Type of Water: Municipal Well Water _ 64NV ���� 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. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Siz Type Building to tank Tank to Distribution Box C Distribution Box to Field/ Pit Opening Sealed: Y N End CaD N Inlet/Outlet Pipes&Baffles Y N Location Separations Foundation to tank ft. Foundation to absorption ft. Se aration of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Locatioa.ef Sys m on Property: f` Fron /ar Left Side Right Side Middle Front Middle Rear m S 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