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2007-445 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. P20070445 Date Issued: Monday, January 14, 2008 This is to certify that work requested to be done as shown by Permit Number P20070445 has been completed. Tax Map Number. 523400-300-016-0001-007-000-0000 Location: 241 FULLER Rd Owner. SHIRLEY CHASE CORMIER Applicant: CHARLES A LOWELL 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, 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: P20070445 Application Number. A20070445 Tax Map No: 523400-300-016-0001-007-000-0000 Permission is hereby granted to: CHARLES A LOWELL For property located at: 241 FULLER 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: SHIRLEY CHASE CORMIER 241 FULLER Rd Septic Alteration Residential QUEENSBURY,NY 12804 Total value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2007-445 SEPTIC ALTERATION RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,July 19, 2008 (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 T July 19,2007 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement '_.___.__.rr_.r...w..................w..._..rr.w...w....w..__.._...... r.._ _ .... ♦_......I 0 OFFICE USE ONLY10 ; TAX MAP NO. PERMIT NO. v PERMIT FEE 11 , 1 o APPROVALS: ZONING TOWN CLERK 1 ; ____w____._..___ ........ . APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC O REVIEW BEFORE ISSUANCE OF A ALID PERMIT. OWNER: /,,CIL INSTALLER: 1 11C—v/EC .ADDRESS: -1 ` Fy ADDRESS: PHONE NOS. 7 r / 0-5'1 PHONE NOS. ` �6 LOCATION OF INSTALLATION: ».»......»».»_......»».....»..........................................................................................._............_.......................................................................................................................... RESIDENCE INFORMATION. YEAR BUILT BEDROOMS X I COMPUTATION= _ TOTAL DAILY FLOW . .................................. . .......... ......._...»». ».,.....»...t.................................... .....,...........................„...........„..........,............ .........................................1 GA RBAGE». 1980 or older X 150 gallon per bedroom _ � � ! INSTALLED?R GRINDER 1981»-1991M...............................».................. X... 130 gallon per bedroom......i...�..i.......... SPA OR HOT TUB »................. a.........................................................d.........................................................................` I ..................... 1992•present j X i 110 gallon per bedroom INSTALLED PARCEL INFORMATION: ✓ TOPOGRAPHY: LUNG STEEP SLOPE %SLOPE ✓ SOIL NATURE: SANDFLA LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? BEDROCMMPERVIOUS 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 MIINUTE 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). Add 250 gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub. ✓ SEPTIC TANK: ©� GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH `5-0 FT. ✓ TOTAL SYSTEM LENGTH: 2 J FT. SEEPAGE PIT(S): HOW MANY? ✓ SIZE OF EACH FT. X FT. ✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS—hl ::�-FT. ✓ BED SYSTEM SIZE: X ✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE ✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH ✓ GALLONS./TOTAL CAPACITY., GAL. l.»....................,.....,.....,..»...............:.................................................................................:...........,................:...............:...............:.:.......,...........,.,,..,.......,.,...............,,,.........,.,...,...,....,.........,........,,........,.........:.................... .......,.:.:.,, 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 (:14 TIONS? CALL 761.8266 OR EMAIL bury Sanitary a Dispo I Ordinance. codes0aueensburv.net j `© R WEBw.ci FOR MORE INFORMATION 171 (fit/J www.aueensburv.net S ature of Person i6sponslble ate Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804 1+{i a 3 3 r Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm part: am/txn 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: PERMIT NO.: LOCATION: INSPECT ON: RECHECK: Comments and/or diagram Soil T m Clay Type of Water: We Well Water. Waterline separation distance ft. Well separation distance ft. Other wells: ft, Absorption Field: Total lengthft. Length of each trench ft. Depth of trenches Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size - Tpe Building to tank Tank to Distribution Box Distribution Box to Field Pit IN opening Sealed: N Partial End Ca In Outlet Pipes&Baffles Y N Location Separations Foundation to tank ft. Foundation to absor io ft. Se ration of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of System on Property: Front ea Left Side C-qde Middle Front Middle Rear m s• Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Last revised 021006 Last revised 1/6/05