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2007-575 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 4z Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20070575 Date Issued: Monday, September 17, 2007 This is to certify that work requested to be done as shown by Permit Number P20070575 has been completed. Tax Map Number: 523400-226-019-0001-053-000-0000 Location: 3 NORTH Ln Owner. CHARLES W CHRISTOPHER Applicant: CHARLES W CHRISTOPHER 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 ('-� j j'' property owner of the responsibility for compliance with Site Plan, �-4/) 4�t— Variance, or other issues and conditions as a result of approvals by the Director of Building&Obde E orcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Qmensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20070575 Application Number. A20070575 Tax Map No: 523400-226-019-0001-053-000-0000 Permission is hereby granted to: CHARLES W CHRISTOPHER For property located at: 3 NORTH 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 QueensburyZoning Ordinance. Type of Construction Value Owner Address: CHARLES W CHRISTOPHER 4B DERRY Ln Septic Alteration Residential LATHAM,NY 12110 Total value Contractor or Builders Name/Address Electrical Inspection Agency MORNING STAR SEPTIC Plans &Specifications 2007-575 tank replacement only $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 17, 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 o tiv 4ts eptember 17, 2007 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement .r. '. . ....r..rw...r.r.wr.rr r.w.wrwr r.. .w ..w ww www.ww.wrw..wwr.wr w..� w..r.rwrww .w.. w www off` j OFFICE USE ONLY / % E C O W E I r JJ J .0 n:. TAX MAP NO. PERMIT NO. PERMIT FEE O2 J , IqFp 1 1 2007 0 APPROVALS: ZONING TOWN CLERK_ , d , I '.w..wwwwwwww_wrr_ww.rww_r_rw_w__wr_rw__r_r _www.w. . ...w.r..r. w', � rp�,0 , APPLICATION FOR SEPTIC DISPOSAL SYSTEM P DINS } A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: /��T� 41Q IIq INSTALLER: ADDRESS: ADDRESS: PHONE NOS. C�9 PHONE NOS. LOCATION OF INSTALLATION: I'-t-bc y-e— ......................................................................................................................................................._......... RESIDENCE INFORMATION. iNO.OF ; } i..................................................................................... YEAR BUILT I BEDROOMS I X I COMPUTATION= _ TOTAL DAILY FLOW ! NC , ._.............................................1.........,...........,......................i........... ...................:...............-...........................,..................1 G 1980 or older , IX 150 gallon per bedroom i = 3C.1G 1 INSTALLED?RINAli R A �(� i _.........._. ..................:.........................._................;....................................................................................t.................................................................................... 1 1981 -1991 X 's 130 gallon per bedroom ? _ 1 SPA OR HOT TUB _..........................................:..............................................a...........a......................._................................._..........,..s...........;.......................................................................... ; I 1992 present X 110 gallon per bedroom i ; INSTALLED?.? o 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 A14 PER MIINUTE PER INCH (TEST TO BE COMPLETED BY A LICENSED PROFE SIONAL 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 [each field for each garbage grinder, spa or whirlpool tub. �� � ✓ SEPTIC TANK: 10 6 o GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT. ✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY? ✓ SIZE OF EACH FT. X FT. ✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT. ✓ BED SYSTEM SIZE: X ✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE ✓ HOLDING TANK SYSTEM:(if required) NO. OF TANKS: 1 SIZE OF EACH ✓ GALLONS./TOTAL CAPACITY. GAL. ..............................:...................:..:.:.:.........:...........................:...............:...:.:...:.:.:...:.:...:,.,.:.:.:.:.....:.......:,.....,.:.:.:.:.:.:...:...,...:.:...........:.:.:.:.:.:...:.........................:.:.,.:.,...........:.,...........................,...............:.,.........,....,..:........... E: AL NOTE: SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN 1 .1 APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. ......................................................................:.............,,....:.,..,.,,,,,.,.,,.,,:,.,.....,..........:.,.,:..............,...:.:......................... :....,...::........................................................................ 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 761-8256 OR EMAIL Queensbury S itary Sewage Disposal Ordinance. nodes O cueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION www.aueensburv.net Sig re of Pers esponsible Date Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804 Septic Inspection Report I Office No. (518) 761-8256 Date InsP�Ion uest received: 1 jo-7 Queensbury Building &Code Enforcement Arrive: . ` am/l epa : am/pm 742 Bay Rd., Queensbury, NY 12804 Inspecto 's Initials. NAME: PERMIT NO.: LOCATION: 2, INSPECT ON: RECHECK: 1� 1 *1 Comments and/or agram Soil T nd Loam la Type of Water: Munici e I Water .� Waterline separation distance ft. /�j�/k �� �f�C�C—h(f:4) '`-� 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 Si Type Building to tank Tank to Distribution Box of 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 Prope Front Re Left Side Right Side Middle Front Middle Rear S U t 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 ,. /� ,� e a n � e � �� a e l� �J v� TOWN OF QUEENS-'. . ` BUILDING & CODE- eiviewed By: I Date: X (0 CD 1 O1