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2008-616 (2) 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. P20080616 Date Issued: Friday, November 21, 2008 This is to certify that work requested to be done as shown by Permit Number P20080616 has been completed. Tax Map Number. 523400-302-009-0001-02 1-000-0000 Location: 5A REGINALD Dr Owner. JAMES & JOAN LUDWIG Applicant: JAMES & JOAN LUDWIG 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 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 onrement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 4:2L 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20080616 Application Number. A20080616 Tax Map No: 523400-302-009-0001-021-000-0000 Permission is hereby granted to: JAMES &JOAN LUDWIG For property located at: 5A REGINALD Dr 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: JAMES &JOAN LUDWIG Septic Alteration Residential 610 HOLLYWOOD Ave HO-HO-KUS,NJ 07423 Total value Contractor or Builders Name 1 Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St QUEENSBURY,NY 12804 Plans &Specifications 2008-616 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,November 18,2009 (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 Towa.Qf Queens ury; Tuesday,November 18,2008 SIGNED BY for the Town of Queensbury. Director of Building Co nforcement ` .----_-_-"OFFICE USE ONLY . -- ---- �.` _ __.% ,.rr____________________ TAX MAP NO. PERMIT NO. l/u ERMIT F APPROVALS: ZONING TOWN CLERK l hptr / I '---------.-----------------------r rrr_r-.r.r r-r rr.-• -r..rr..r.__.r..r.rr.r-r-rr-rr.r ~'.- ---------_--_- 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. OWNER: M - INSTALLER: & � f� ADDRESS: ADDRESS:. 1(2 PHONE NOS. PHONE NOS. c` LOCATION OF INSTALLATION: NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATI = = TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = 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? ✓ 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). TANK SIZE: /j 0- 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 lengtl SO ft. Each trench �� X t ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? 1" ❑ ALTERNATIVE SYSTEM Bed or other type? /V ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? XIA 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 S ary Sewage Disposal Ordinance. codes(ilaueensbury.net VISIT OUR WEBSITE FOR MORE INFORMATION www.gueensbury.net SCre of Person Responsible Date • To7vn of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804 B 5-LGL 6166 !f Septic Inspection Report Office No. (518) 761-8256 Date Ins ig�equest received: Queensbury Building &Code Enforcement Arrive: am/pm p rt: am/pm 742 Bay Rd., Queensbu , NY 12804 Ins s Initials: ' j NAME: (_._ <. W PERMIT NO.: LOCATION: o� INSPECT ON: - RECHECK: Comments and/or diagram Soil T Loam/ Cla Type of Water: unici a Well Water Waterlin ration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length Length of each trench ft. Depth of trenches ft. Size of Stone 4L Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box `L Distribution Box to Field / Pit :< 1' Opening Sealed: N End Cap Y N Inlet/Outleftes &Baffles Y N I-aCation Separations Foundation to tank Foundation to absorpWn Separation f 0 Z ft. Conforms as Plot Plan Y'F N C Engineer Report nd As-Built N Location of System o "*f�--1 Front �Re Left Side Right Side Middle Front Middle Rear s mU t 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-OLD\Building&Codes\Inspection Forms\Septic Inspection Reportdoc r t J i a f i � y _ .1 - _ mil_ ao AA7 i I z 4 x { J i i dd