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2005-282 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: P20050282 Date Issued: Tuesday, May 17, 2005 This is to certify that work requested to be done as shown by Permit Number P20050282 has been completed. Tax Map Number: 523400-296-012-0001-013-000-0000 Location: 32 BAYBERRY Dr Owner: DOUGLAS COON Applicant: DOUGLAS COON 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 property owner of the responsibility for compliance with Site Plan, ✓Q( 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: P20050282 Application Number: A20050282 Tax Map No: 523400-296-012-0001-013-000-0000 Permission is hereby granted to: DOI ICTLA S COON For property located at: 32 BAYBERRY 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: DOUGLAS COON 32 BAYBERRY Dr Septic Alteration Residential Total Value QUEENSBURY, NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2005-282 SEPTIC ALTERATION $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, May 06, 2006 (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 Tpwro.Qf Queen ury; ri ay, May 06, 2005 SIGNED BY C for the Town of Queensbury. Director of Buildin Co nforcement ��►(� .� a - � - ice. Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 7"61-8256 1. OWNER INFORMATION: .................................... .................... // Office Use Location of installation: r —T File Pe�mit NO. f U Tax Map No.' �,/2/ Fee Paid Owner's Name: Tie<<< As l,! C111 iti Address: r D� �' �IZZ /a 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of SS bedrooms with applicable gallons per bedroom to equal total daily flow) j Year of House: No.of Bedrooms x Cgn utation = Total(Daily Flow 1980 or older x 150 gal/bdrm = 1980-1991 x 130 gal/bdrm = 5" 2 1991 -present x l gal/bdrm = Garbage Grinder Installed yes_ / no �,vD Spa or Hot Tub Installed yes— / no ✓ R�C IM Y �) 3 2t10� 1 4. PARCEL INFORMATION: (circle applicable information&indicate me' ss TAN OF QUEENSBpURY 14"araDhv Soil Nature Ground Water Bedrock or Impervious M iN ater Su 1 Flat sand at what depth at wh depth municzpa oiling loam i0 "feet &, feet well Steep slope qc1a if well; water supply ^%slope from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: 1-%5 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 Tub. Septic Tank: /-)-r0 ' gallon(min. size 1,000gal.) Tile Field: each trench�ft. Total System Length: ft. i Seepage Pit(s): number of size of each: ft. b� ft. i Size of Stone to be used: # ! depth or thickness feet, Bed System Size: x Alternative System: e ('length and/or size AM r 6. HOLDING TANK SYSTEM: (if required) Number of tanks: I 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-, 9 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 of Queensbury Sanitary Sewage Disposal Ordinance. th wn Signature of n6sponsibie person date 5r•.tivcm :Intl "Rewilge Disposal (,it:tpiel. lei pomli x t• r . 'iRI:I'/1'1LA'1'ItJN t�:I����Ji Itt+itil I��Il1'1� ' WELL W umert• \ � rt u•.v t ' '; •tuts c�nlc� .. +•- • 1SOU3E Ci �� - , ��v lip->t G E j j ! tt!rnttnttc�) i F"tRt..b I I A ROM) i , 7, SICN,&TURE &JNpojMATIQIj FM=rVN;SWLr.,rr4%.OVW4�r,�+»•�..�..., 1 ! I I O i Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ /Depart: am/pm 742 Bay Rd., Queensb�u-try,NY 12804 Inspector's Initials: t/ NAME: CDC PERMIT NO.: LOCATION: l dZ INSPECT 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. Abso tion 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/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 Midd/FroMliddle Rear S stem Use Sved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LaSueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No.(518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/p Depart: pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: ' NAME: PERMIT NO.: LOCATION: �, {Sx?.� � i7,��. INSPECT ON: _ RECHECK: Comments and/or diagram Soil Type: San Cla Type of Water- ipal Well Water Waterline sep4ration dist ce ft. Well separation a ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone L Seepage Pits: Number Size: x Stone Size: Piping Si T e Building to tank leor Tank to Distribution Box K Distribution Box tq Field/Pit_ I Opening Sealed: Y/N/Partial End Caps Location/Separations Foundation to tank ft. Foundation absorption ft. / Separation off Pits ft. 604066� 3� 'g 5W4� Conforms as per Plot Plan N Engineer Report and As-Built Y N Location of System on Property: Front ear Left Side 'ght ide Middle Front Middle Rear System Use Status: roved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved Last revised 116105 Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: lr t J am/ mI Depart: _am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: ' e, NAME: , PERMIT NO.: Q;j.Z3'2- LOCATION: ? 2- ;�� INSPECT 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. cvmow.,,-p i 4 Depth of trenches ft. Size of Stone Seepage Pits: Number Size: Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial End Caps 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 1/6/05 LU U1C=) > LLLUJ .4 1' MO-W LLI 00 U1 CQO ...... Or .......... ........ I have seen. or observed, or believe I saw evidence of, all ob,er,,ts such as houses, wells, trees, fences, etc., s h�uw r on this document. I also represent that I have y r4t person rn asured the distances set forth on the diagram." S NA LI R E DffE— Ln TW EP BUILDING REVIEWED BY DATE