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2004-003 iAMINA, TOWN OF QUEENSBURY FAT 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20040003 Date Issued: Thursday, January 27, 2005 This is to certify that work requested to be done as shown by Permit Number P20040003 has been completed. Tax Map Number: 523400-296-007-0001-012-000-0000 Location: 653 BAY Rd Owner: ADIRONDACK MANOR HOME FOR ADULTS Applicant: ADIRONDACK MANOR HOME FOR ADULTS This structure may be occupied as a: By Order of Town Board Septic Alteration Commercial TOWN OF QUEENSBURY JG Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 107:0 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20040003 Application Number: A20040003 Tax Map No: 523400-296-007-0001-012-000-0000 Permission is hereby granted to: ADIRONDACK MANOR HOME FOR ADil,TS For property located at: 653 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: ADIRONDACK MANOR HOME F 653 BAY Rd Septic Alteration Commercial Total Value QUEENSBURY, NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency I.B.S. SEPTIC `rl 2 LOWER WARREN STREET OI TEENSBI TRY_ NY Plans&Specifications 2004-003 COMMERCIAL SEPTIC ALTERATION $35.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, February 10, 2005 (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 Town of Queensbury; Monday, January 05, 2004 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System / Town of Qllee'nshiuy7.1213ayRoad Queensbiirv, NY 12804 (5 lb) 761-8256 1. OVER INFORMATION: I Location bf installation: 653 Bay Road Of(icc Use Filo Permit No. ON Iwy :! Tax Map No. 296.7/ 1 / 12 1� Fee Paid 3 O4) Owner's Name: Adirondack Manor — Home for Adults �' Address: 634 Plank Road, Suite 102 Clifton Park, NY 12065 2. INSTALLER'S NAME : IBS Septic PHONE NO._V 1. /C D 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 11 bedroom(s) and multiply II of I V G bedrooms with applicable gallons per bedroom to equal total dailyflouJAN 0 2 2004 Year of House: No. of Bedrooms x Computation = Total Dail Flor_vTowN OF QUEENSBURY BUILDING AND CODE 1980 or older x 150 gal/bdrm = 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes / no BASED ON EXISTING WATER USE Spa or Whirlpool Installed yes— / no 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) SEE PLANS TopogtlI.p liy SQiI N_attir9 crpu„d Water Bedrock or impervious Material Domestic Water Supply Nat sand at what depth at what dchth municipal Rolling loam fret fret well Steep slope clay if well; water supply ____%slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or architect) • Rate: _ minute per inch 5. 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'Fob. SEE PLANS Septic Tank: gallon (min. size 1,000 gal) Tile Field: each trench - ft. Total System Length: __fl. Seepage Pit(s): number of size of each: ft. by ft. • Sizo of Stone to be used: lI / depth or thickness fret Bed System Size: x Alternative System: length and/or size • 6. HOLDING TANK SYSTEM: (if required) N/A Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON (please read) 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 re!ulations with respect to this application and agree to abide by these and all requirements of 1 , W +wn of Queensbury Sanitary Sewage Disposal Ordinance. `� r 2 °¢ Signat : of responsible person ate F f Town of tltic:eftybury ,Sewers :end Sewage Disposal (:haI)ier Append;t (: ABSORPTION OIt1''I'ION I"I ELI ) SI;I'i1 ItATI(JN ItEtll-1I ItI,f111':N'1'S - \....\ .;i Rt-:MA _ J eft POND v_oj, \ — 1) . t''l�u_ r„ VAT R. `� .-/Mr:r li'n••7 -tv./r/Ir c.A5Itici ./. .r ,2,...__. r 1--- 1/ y -r/. —. ...— — —7 L. IS0U_SE: 6 nE / ; ,�'"ttl�," - IIc)OS Gv��r3E -4 1 • -- iT ' SG f'I IC. ' � II j li )r•., ,v_ rcjb-1)3 \----.......____ 1 / VIR.Lb I : _________ \........__ (_----- -------1.--------- P.0AD - —'r' Septic Inspection Report Office No. (518)761-8256 Date Inspection req. - e zv:•: Queensbury Building&Code Enforcement Arrive: a . ►epart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: 2CC . -- tC -27 NAME: IADtQc.). n M rs>c-)P_ P, RMITNO.: LOCATION: ((-y ) SPECT ON: ` RECHECK: • Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. 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/Partial Location I Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. C (\L r j \L:- Conforms as per Plot Plan -Y—N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Stairs: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 • Septic Inspection Report Office No. (518)761-8256 Date Inspection re st c ' e : Queensbury Building&Code Enforcement Arrive: A part: \\".lim 742 Bay Rd.,Qu ensbury,NY 12804 Inspector's Initial • NAME: ? £TON: NO.: a 4 oo.? .. '• LOCATION: - 0 11 RECHECK: Comme.is and/or diagram Soil Type. Sa . oa-a/Clay Type of V6 'cipa /Well Water Waterline separation istance ft. L.,vc.riciz. 0. Well separation distance ft. Other wells: _ft. 1\( )FSTH , ) Q. Absorption Field: Total length V-1—k ft. Length of each trench \c(,'7l ft. Depth of trenches -'?� ft. Mc Size of Stone ‘t 1'L - `Oes.\-a'Z 1_ (E Seepage Pits: Number h- LO Size: x Stone Size: 1 (C. Piping Size Type Building to tank `L 1 w b Tank to Distribution Box L-I Q'-rj Distribution Box to Field/Pit y-l 'I ,�� ti Opening Sealed: Y/N/Partial / \ Location/Separations C\' Foundation to tank - �----it Foundation to absorption / ft. f . Separation of Pits ft. Conforms as per Plot Plan Y_N" Location of System on Propekty: e i Front Rear Left ide Right Side Middle Font ddle Rear Ikl--) E.Q.._ _ \t. ..... .Q_'t_i VL Ri S stem Use S tus• proved /Partial Approved and needs to be re-inspected,please call the Building&Codes Office ,.;` Disapproved G4SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 6 Septic Inspection Report Office No. (518)761-8256 Date Inspection re, - eceiv Queensbury Building&Code Enforcement Arrive: :m/p• ►. ..rt: 2. a p 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: /// NAME: A n% C- A.Le t--14\0 v. IT NO.: ' --`9 Ce` LOCATION: V)A" V-- SPELT ON: 1 2 '--\ RECHECK: • Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Absorption Field: Total length F%Fi D 'Z • ft. Len, h of each trench1111 v ft. —�! D1-i De•th of trenches _ ! _ _ ft. Eaopku __ _ Size of one Seepage Pits: Number \0 1��-CRF tjR Size: x • Stone Size: Piping Size Type (y 'To C3 /1- Fi` i .. -) Building to tank ;�jU1 Tank to Distribution Box F'\Distribution Box to Field/Pit + Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft._ \c) c,J 1P\ \--T ot, J6 Foundation to absorption ft. Separation of Pits ft. / Conforms as per Plot Plan �/Y N Location of System on Property: �A�T\AL Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: / Approved J Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:'\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 r. t..........................................................................., Town of Queensbury ci & 0 ,01 (11, Fire Marshal's Office .�- vet-- 742 Bay Road '1 trq e I v't v1.G Queensbury, NY 12804 Phone (518)781-8205 FaX(518) 745-4437 I/ Fire Marshal's Inspection Report Request SCHEDULE Received: __ __Permit# &o 0 4 —�o9 INSPECTION ON:_„- .' � ,�" ' '7 Name: / (A_, UiA,l ) A 0 NYTIME Location: iA i of l oil (flt1 APPROVED _.____..T.N/A YES NO COMMENTS EXITS AISLE WIDTHS EXIT SIGNS_BATTERY µ -- v c o �� ���L EMERGENCY LIGHTING All 4 FIRE EXTINGUISHERS X FIRE ALARM SYSTEM _ �_ _ FIRE SPRINKLER SYSTEM _____ FIRE SUPPRESSION SYSTEM HOOD INSTALLATION }_ _- INTERIOR FINISHES �- OK C/ �, L` STORAGE �� COMPRESSED GAS _., CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS _ CLEARANCE TO ELECTRICAL w REQUIRED SIGNAGE EMERGENCY PLAN MAXIMUM OCCUPANCY SIGN CHIMNEY MASONRY ROUGH IN FINAL CHIMNEY FACTORY BUILT ROUGH IN FINAL • WOOD STOVE _T ROUGH IN FINAL --._,j VENTED GAS APPLIANCE ROUGH IN FINAL FIREPLACE —� MASONRY ROUGH IN OK T 11 DATE OK FOR CO NOT OK ANAL � FIREPLACE �, .- FACTORY BUILT ROUGH IN _. INSPEC BY ____. FINAL • COMDEviCHRISJMIORD,LETTERS2Q01IFIREMARSHALINSI;'ECTIONREPORT 1102200/ WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY .e. • 6111 Town of Queensbury Fire Marshal's Office 9 )(D 742 Bay Road Queertsbuiy,NY 12804 LPhone (518)761-8205 Fax(518) 745-4437 Are Marshal's Inspection Report 30. 0 Li - 0C25 Request ,00)01-1 __ , S SCHEDULE ) - /5- Received: Permit# (-X) INSPECTION ON: 1 9 - Name: A--'S-K2---Aarl_ic 3;00 AM I:( 41) ANYTIME Location: APPROVED ______. N/A YES NO - COMMENTS EXITS j AISLE WIDTHS -I- .14 e-K.; 5YA) EXIT SIGNS-NORMAL - BATTERY e irvai (icor. EMERGENCY LIGHTING ,,, FIRE EXTINGUISHERS I\ - ri‘V)flifi frkfL,0 A15'C 1 6?kd -Pio_ FIRE ALARM SYSTEM 4 , _ I I FIRE SPRINKLER SYSTEM FIRE SUPPRESSION SYSTEM ' HOOD INSTALLATION A. ‘[.- ( eX /A/T{151{01i -5 7b, miAhmum ) INTERIOR FINISHES X STORAGE X - COMPRESSED GAS- - - X - i CLEARANCE TO SPRINKLERS Ta -- - 0(19' 59 At 5 0 Al 5A (e 5 CLEARANCE TO HEATING - UNITS -000 ( A/aid b utb5 -CLEARANCE TO ELECTRICAL REQUIRED SIGNAGE EMERGENCY PLAN MAXIMUM OCCUPANCY SIGN A CHIMNEY MASONRY ROUGH IN FINAL • _ CHIMNEY 1 FACTORY BUILT ROUGH IN FINAL _ WOOD STOVE ROUGH IN FINALL I VENTED GAS APPLIANCE ROUGH IN FINAL FIREPLACE MASONRY ROUGH IN OK THIS DA - FORTCO NOT OK FINAL FIREPLACE — .e_ _ - FACTORY BUILT _ ROUGH IN ' V-ejtc7--. NSPE FINAL COIVIDEV/CHRISJIWORD/LETTERS2001IFIREMAFtSHALINS CTIONREPORT11022001 WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY 1--R-e AM cEk Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: ' Queensbury Building&Code Enforcement Arrive: arn/itim Depart: am/pm 00 3 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: R 1 ;0 1AC , iNt ptr:.,U PERMIT NO.: C..L; 1-k cjL01 t,1) LOCATION: {VL{ () An INSPECT ON: RECHECK: EPA Comments and/or diagram Soil Type: Sand/Loam/Clay 1 Type of Water: Municipal/Well Water Waterline separation distance ft. � �' - 0 u1 (t3 Well separation distance ft. Other wells: ft. RO 612e-s 5 T< Absorption Field: Total len.th 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/NI Partial Location/Separations Foundation to tank ft. Foundation to absorption _ _ft. Separation of Pits ft. Conforms as per Plot Plan 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 L:'\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003