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2005-288 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: P20050288 Date Issued: Friday, May 06, 2005 This is to certify that work requested to be done as shown by Permit Number P20050288 has been completed. Tax Map Number: 523400-301-019-0001-050-000-0000 Location: 43 FERRISS Dr Owner: TIMOTHY & HEIDI BROWN Applicant: TIMOTHY &HEIDI BROWN This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY r )j W k--.- Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20050288 Application Number: A20050288 Tax Map No: 523400-301-019-0001-050-000-0000 Permission is hereby granted to: TIMOTHY& HF,TDT BROWN For property located at: 43 FERRISS 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: TIMOTHY& HEIDI BROWN 43 FERRISS Dr Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2005-288 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 T Queen ury; i y, May 06, 2005 SIGNED BY AI for the Town of Queensbury. Director of Building Cod nforcement Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use Location of installation: _ 32 File Permit No. Ot�2" Tax Map No. / 1 Fee Paid. Owner's Name: ......................................................................................................................................: Address: —1 2rf i SS � OijewAuCIAY r2966. 2. INSTALLER'S NAME Uhl PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply #of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x ComRutation = Total Daily Flow 1980 or older x 150 gal/bdrm = VE� 1980—1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrmMAY= —� 005 Garbage Grinder Installed yes— / no TOWN OF QUEENSBURY Spa or Hot Tub Installed yes_ / no BUILDING AND CODE 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) TQPo a h Soil Nature Ground Water Bedrock or Im ervious Material DgMSigaXater SmpRly Flat sand at what depth at w�h�aa depth munici oiling oam s feet feet 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 Tub. Septic Tank: I gallon (min. size 1,000gal) /K— �y � i, Tile Field: each trench �5b rft. Total System Length: %sUT ft. ��+ 1�f O/V Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) 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 regulations with respect to this application and agree to abide by these and all requirements of the Town of eensbury Sewage Disposal Ordinance. 5K-6 Signature o responsible person Date COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL lermitNo.......................................*Cert. N'_ 90076 Cut-in Card No........................ ..)wner...... ........................................ .........................................I............................................. c..._. .2.. . . . . .. ............. ,ovation... ...... . .................I. .................................... . ...... ..................... nstallation Consisting of.Av. ...... . . ...................................... ............... .................................................................................................................................................................................. ................................ ............................................................................................................................................... nstalledBy...... ...... .....................................Lic.No................................................... The conditions following governed the issuance of this certificate,and any certificate previously issued is ancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon the ,itroduction of additional equipment or alterations,application shall be promptly made for inspection. Inspectors of this Company shall have the privilege of mAaki.ng ' s ctions at any time, and if its P ct' ules are violated,the pany shall have the right to ev e this rti ate. )ate...�-a�e Coe 0- ....... I .......A............................... INSPECTOR.................. ........................................ ...................... ,,fir• ��- 1 �� Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: a Depart,4 � m/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: �) r c.`.1-l_` PERMIT NO.: LOCATION: P; - INSPECT ON: RECHECK: Comments and/or diagram Soil TypsUAala Type of Waterf MunicipaV Well Water Waterline separatiowdigiance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length l ft. Length of each trench 6w ft. Depth of trenches ft• Size of Stone L Seepage Pits: Number Size: x Stone Size: Piping Size T e Building to tank i �T Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial End Caps Location/Separations Foundation to tank '� ft• Foundation to abso tion ft. Separation of Pits ft L Conforms as per Plot Plan Y N 5�'�' A6 U/L Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear system Use Stati . Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved Last revised 1/6/05 a 9 7p y�7 APIR s P pPR 1994 �� M Received tlA Zoning Ate, `+ a*t Q?� 2 S,l L 0 T �� PaRE EIVED A64X 0 4 Zt�Oa Z-4S TOWN F QUEENSBURY NG AND CODE 3 1 /35 TAc, 9 ( � f /� 4V � � • ,R i 3 'Fo DAM J.BOLSTER (� LI£.LAND SURVEYOR ,�, ( - — — 22 BONNER �p i t '4 :, �- ,... ,k �. Fa t J ter QUEENSOURY,NY 1M - BUILDING S DEP REVIEWED BY DATE '