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2005-293 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: P20050293 Date Issued: Thursday, May 12, 2005 This is to certify that work requested to be done as shown by Permit Number P20050293 has been completed. Tax Map Number: 523400-309-009-0003-085-000-0000 Location: 50 NEW HAMPSHIRE Ave Owner: CARL LASHWAY Applicant: CARL LASHWAY 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 ;l 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: P20050293 Application Number: A20050293 Tax Map No: 523400-309-009-0003-085-000-0000 Permission is hereby granted to: CART,I,ASHWAY For property located at: 50 NEW HAMPSHIRE Ave 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: CARL LASHWAY 50 NEW HAMPSHIRE Ave Septic Alteration Residential Total Value QUEENSBURY, NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2005-293 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, May 12, 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 wn of%tw sday, May 12, 2005 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement 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: Al' i I File Permit No. Tax Map No. Fee Paid Owner's Name: SqwA ti ..................................................................................................... ............ Address: 2. INSTALLER'S NAME "V 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 Computation = Total Daily Flow 1980 or older x 150 gal/bdrin = 1980- 1991 x 130 gallbdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes— no Spa or Hot Tub Installed yes— no of 9 - 3 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Toi)o=-Dhv . Soil Nature Ground Water Bedrock or impervious Material Domestic Water S=ly ' Flat qsan at what depth at what depth municipal m ngg 0am feet —feet well Steep slope clay if well; water supply %slope other from any septic-system depth: absorption is 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: gallon (min. size 1,000 gal.) Tile Field: each trench_ft. Total System Length: Seepage Pit(s): number of size of each: _j?. by_ft. RECEIVE of D Size Stone to be used: # depth or thickness feet MAY 0 9 2005 Bed System Size: x TOWN OF QUEENSBURY BUILDING ANDLODE Alternative System: -Z N X,zAiq i o 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 Queensbury Sanitary Sewage Disposal Ordinance. Signature of responsible person Date ,'I'otivll of Qw-wil abury Srwc:ra and .'Cwit�;C Uisim.,4al (:I1:1I)it•t• A-11SORI''1 ION, FIELD • SI:i'/1'ItA'I'Ita1�1 I�:I�t��Jiitl�ltill�.[�3'I`;; ' POND 1..�.+ H/�Lt. tN )I(►Tf'i�• -i fit lt'►yR • _........_._... •t�,uc c�S�•ICE MT r~4��i"'`.... 1Souzc t3 fir >, '• 11,.>�ts>r G , t 3 l�y3nRt►ttos t P U> I � ' I Septic Inspection Report Office No. (518)761-8256 Date Inspection r ues ecei d: Queensbury Building&Code Enforcement Arrive: o m/ epart: am/1 i j 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials- NAME: (�lilA �i. P IT NO.: LOCATION: _ SPECTON: ,57--1Z—C),C _ RECHECK: Comments and/or diagram Soil T e. San L-pan440ay Type of Watef.---?duniclpV Well Water Waterline se aratlon istance 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 5 Seepage Pits: Number Size: x Stone Size: Piping TSize Type ._ Buildingto tank Tank to Distribution Box Distribution Box to Field!Pit Opening Sealed• Y f Partial Location/Se arations Foundation to tank ft• Foundation to absorption ft. Separation of Pits ft• Conforms as per Plot Plan N Location of System on Property: Front Rea<=LIight 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 77/-0v71 Septic Inspection Report Office No.(518) 761-8256 Date Inspection re st re eive / Queensbury Building&Code Enforcement Arrive: m/pm Jpart: rtf 742 Bay Rd.,Queensbury,NY 1,2804 Inspector's Initi NAME: LOCATION: (�j� .,\ r � -�\J F P ECT ON: RECHECK: 1 Soil Comments and/or diagram T 'la -Type of Water: Well Water Waterline separation distance Well separation distance ft. Other wells: ft. Absorption Field: Total length 4t - ft. Length of each trench i144 ft. -Depth of trenches ft. Size of Stone -Seepage Pits: Number Size: x Stone Size: Pi Ing Size Building to tank -- Tank to Distribution Box AN Distribution Box t ield/Pit Opening Sealed Nl Partial � C_�L_0 `l � 1 %u Location/Separations 'vE Foundation to tank Foundation to absorption ft. 1-�- Separation of Pits ft. � Conforms as er Plot Plan N Location of System on Property: Front Re,(Left Sid R� Side Middle Front Middle Rear System Use Status: pproved 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 sa IMF ^9 I .a a .a i:- observed, ;i ':'U- i S3°dv` evidence nr Jr:rf J , s houses, we-J,s, t,re s, ien-,,s, etc., �U� ING 11ment. I also reoreseF t that I had the stances set forth on the drag PC-FiEV1 WED B , 1 JAT ° BUILDIN / — --— 3 RAM- m sesc/b+ ( lC, E prrDEDEPTH AND TEST 17•w f4 AT BOTTOM OF PIT) 2 461 h i SOB°43-17•w t 1 BB.38' I I 41 I 1 n 1 8 L4 —=---— 10 I 1 6,465� sq. ft. o 4 0.15 acres AT NOD I I� ^ o � y EXISTING .,� 1--1/2 STORY Cu 37 WOOD FRAME o HOUSE x N08'48'11-E IN i-e% .C., '`�jipent that I h f�F•e per t N.V.'s on the NE TE JL