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2003-668 eak 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: P20030668 Date Issued: Thursday, January 29, 2004 This is to certify that work requested to be done as shown by Permit Number P20030668 has been completed. Tax Map Number: 523400-289-010-0001-016-000-0000 Location: 24 JAY Rd Owner: DEAN REALI Applicant: DEAN REALI This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement ��` TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 F4,0 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030668 Application Number: A20030668 Tax Map No: 523400-289-010-0001-016-000-0000 Permission is hereby granted to: DEAN REALT For property located at: 24 JAY 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: DEAN REALI SUZANNE RAYESKI Septic Alteration Residential Total Value 24 JAY Rd LAKE GEORGE,NY 12845 Contractor or Builder's Name /Address Electrical Inspection Agency I.R.S. SEPTIC 2 LOWER WARREN STREET OI JEENSRI JRY.NY Plans&Specifications 2003-668 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 14,2004 (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 n of eens ry; , , August 14,2003 40, 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: (Je y ,;r File Permit No. t 3- Co 2 Tax Map No. / / Fee Paid as- go Owner's Name: /)tea o f /c1" ? /7 Address: ()� i f?c17 4?(/( e-, fjpe ,/ 2. INSTALLER'S NAME : Cac ,JCp /-("" PHONE NO. ie l S t' 0 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/bdrm = 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes / no — l Spa or Hot Tub Installed yes_ / no / `' - AUG 1. 2003 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) T� J`'Y Topography Soil Nature Ground Water Bedrock or Impervious Material l fie 'atci'Su p/7 FI > sand at what depth at what depth municipal Rolling Cloak- 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: /ItsC7' gallon (min. size 1,000 gal) .2 SG' Tile Field: each trench S ft. Total System Length: '" ft. 2-W 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 ofkiwn of eisb r Sanitary Sewage Disposal Ordinance. il , ..„.„‘.,,, 2,._,,,..S, .6" 7 Signature of res sible person Vi) t-- Tu PcM VI Septic Inspection Report SZ 7/6; Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: c /O am/pm�_ Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: �',ir— NAME: - - L 1 PERMIT NO.: (Q�o LOCATION: `'1 .J A •,( (z�'� aj INSPECT ON: Z ' 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. r 2 keS Absorption Field: Total len,th ft. ((de'Length of each trench ft. _ ) Depth of trenches ft. tort( (;8 �d.r ��� Size Stone Seepage e Pits: Number /OD Scl' 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 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 4. 30 t 7' \\,,/ Septic Inspection Report Office No. (518) 761-8256 Date Inspectio request received: Queensbury Building&Code Enforcement Arrive: /t am/pm Depart: am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: IV- Y V NAME: 'C`�,� i 1 `C1 PERMIT NO.: � _,- LOCATION: ' CA - C,.,,,i INSPECT ON: 3 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 3'I Uz- ft. `` Depth of trenches 3-. ft. ¢,//i .L 2 //'pi ° Size of Stone N� Seepage Pits: Number ` �� 'f3aip Size: x Co r cife- Stone Size: 44 /-Z r' • Piping Size Type L/ /` `lZ/ Building to tank _ i; PUL ri-tatit. �7 ui-Ci ( . Tank to Distribution Box C/h ca. Distribution Box Field/Pit E,Z Opening Sealed Y N/Partial Location/Separations � hmFoundation to tank ft. ()Air fi 4.' Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan ----Ty N Location of System on Property: Front Rea Left Side Right Side Ge,e_ Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingwayU3uilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 -J A ' 1 (,..".„• . .....)• 0 1 --____________„ __• ry `,'- ;co ----. - ..mac � TOWN OF QUA* J�• s" 9 S. S7� C.Z �/'� M„Ob ,SZ 099 N 17N0 3/1 �11�—, - •DE ,Aflod•11' a( ,I ,`VIEWED BY �,:Q'I AUG ' : ?����:Li , \/ it r ,Y I i y° / Y �MOh/� Ob/bH J7� / IN/ • , 0,9 aLl/0.1 /(441 `.. X .0 SONb'7 a • ' • I 1 , � 4Jo,s f el iv ,t � 9 �0 . • 3o I ,c, / /..,,, r. 1 21,4,..) / o iJ d - £1 d I M aA/JO a /J,p a5oio9 {0 1 1 ;. • • . - ' / • .YNy ar'v �„ / . � /_ 4 Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: 316 am/ Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: °s` -)C% ; 1 Y-\ PERMIT NO.: QJ- �Yj2 LOCATION: aL�j� INSPECT ON: 73---a(-)-C. RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. c�- c+ Other wells: ft. Absorption Field: Total lent h ft. 4 r �3 '— Length of each trench ft. G�t cr� 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 Middle Front Middle Rear System Use Status: Approved N 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 lituize_p_4(4...._ V 1 /(), U Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: ')'34, am/pm I ,Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: sU NAME: c-C:2Z2C2kX1 (3NN, C PERMIT NO.: — LOCATION: INSPECT ON: j 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 len: h , ft. Length of each trench ft. /I Depth of trenches ft. 1�+v ,!V U � r ���Size of Stone �Seepage Pits: Number SJ Size: x 1y-- Stone Size: P Piping Size Typ 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 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 J.{,:.(,..s . . ......>" ___--_____.--- . ;77— -------'`,..„. / ..,i ie''"" .\.•';N:,", / 1 '4str -lam' � i.• M„Ob ,9l-.99 N TREC8VE ( 'i., NV ( :-.:. B r.. / il \'. AUG 1 3 2003 u RDy ( ita el A ii • . 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