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AS N077�L?., . , - b . { r, " Ali'hi TOWN OF QUE E NSB URY 742 Bay Road, ensb NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20100356 Date Issued: Tuesday, January 25, 2011 This is to certify that work requested to be done as shown by Permit Number P20100356 has been completed. Tax Map Number. 523400-289-010-0001-005-000-0000 Location: 18-20 JAY ROAD EAST Owner. ROBERT & CAROLYN ACCARDI Applicant ROBERT & CAROLYN ACCARDI 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 ;x vik ; 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. 404 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20100356 Application Number. A20100356 Tax Map No: 523400-289-010-0001-005-000-0000 Permission is hereby granted to: ROBERT& CAROLYN ACCARDI For property located at: 18-20 JAY ROAD EAST 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: ROBERT&CAROLYN ACCARDI 9 HOYT Ave Septic Alteration Residential GLENS FALLS,NY 12801 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2010-356 SEPTIC ALTERATION RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,July 26, 2011 (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 Tyf,\Quee uryi ,7 day,July 26, 2010 r SIGNED BY ,1 i� r ' for the Town of Queensbury. Director of Building&Code Enforcement OFFICE USE ONLY TAX MAP NO. --ate PERMIT NO. J PERMIT FEE___25____ , ' APPROVALS: ZONING i1P TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM • A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT PERMIT: :: çit /� TO REVIEW BEFORE ISSUANCE OF A VALID , C( 4ir INSTALLER: - S�Ip 1 C ADDRESS: I ,11 1 `d i t.-..) ADDRESS: 2 LO e �grrfr , S t` . PHONE NOS. �� fl's 61 q PHONE NOS. 1 / 0'�i LOCATION OF INSTALLATION: ? V cA YEAR BUILT NO.OF X COMPUTATION= BEDROOMS RESIDENCE INFORMATION: 1980 or older = TOTAL DAILY FLOW X 150 gallon per bedroom _ GARBAGE GRINDER 1981 1991 X 130 gallon per bedroom = INSTALLED? 1992-present X 110 gallon per bedroom - SPA OR HOT TUB INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steepslope %Slope ✓ SOIL NATURE: Sand Loam Clay Other______ ✓ GROUNDWATER: At what depth?_VAL_ ✓ BEDROCK/IMPERVIOUS MATERIAL: At what depths — ✓ DOMESTIC WATER SUPLY: Municipal p Well ti (If well: Water supply fr nyseptic system absorption is ft.)1\11. ",/ PERCOLATION TEST: Rate is M I L SC(� per minute per inch. (Test to be completed by a licensed professional engineer or architect.) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision). designed by TANK SIZE: LGALLON slon)(MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. �i SYSTEM TYPE: ��1.\- 0 ABSORPTION FIELD (WITH NO. 2 STONE) Total length_ IV P 0 SEEPAGE PIT(S) (WITH NO. 3 STONE) How g� ft. Each trench X many. ALTERNATIVE SYSTEM Bed Size? or other type? 1 �,j i,� fir.\n i t IV k 0 HOLDING TANK SYSTEM v I Total required capacity? Tank size? Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 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 failure to make a material fact or circumstance known by or on behalf of an applicant, shall be voidresentation or I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL Queensbury Sanitary Se age Disposal Ordinance. codes@aueens-1-ii- bur net t VISIT OUR WEBSITE FOR MORE INFORMATION Signature of Per on Responsible Date "'"—r'".gueensburv.net Town of Queensbury • Community Development Office • 742 BayRoad,, Queensbury,NY 12804 • Septic Inspection Re Office No. (518) 761-8256 Date Inspection -.,uest '-c ' ed: Queensbury Building&Code Enforcement Arrive: - :m/p part: 3 ;VC am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initi. s: 1 NAME: 1k� �(7 I • • IT NO.: \U 35-(c> LOCATION: (66 -7 iT", K7) Ems' f PECT ON: —2-Lk—1 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. Well Casing Length 50' +/ - Y N N/A [150'to well required if NO] 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 End Cap YN Inlet/Outlet Pipes&Baffles Y—N Manholes 12"or less below grade _Y N [provide extension collar if Yes] Y N Location/ Separations Foundation to tank ft. Foundation to absorption ft. • -tion of Pits ft. i e,) ' A •• •rms as pe• Plo ' an _ •ineer Re,•; - • -Bu Y N enance • •act _Y_ N provided Location of System on Property: Front R r Left Side Right Side Middle Front Middle Rear m Use Sta s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved l:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Repork_03 29 10.doc '1\ (7 :o ) /-- 3 715-esi Septic Inspection Re• • Office No. (518) 761-8256 Date Ins req - Queensbury Budding &Code Enforcement Arrive: :` a, /p j -part: - . • pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials Ii NAME: E' NO.: 3 4, LOCATION: Ill-Z I •PECTON: -AMP'd RECHECK: Comments and/or diagram Soil Type• Sa ,/ Loam/Clay Type of Water: icipal/4ef1 Water) Waterline separation distance ft. Well separation distance WO ft. Other wells: ft. kd i Well Casing Length 50'+/ - Y N N/A [150'to well required if NO] Absorption Field: Total length ft. Length of each trench 1Lw ft. Depth of trenches ft. Size of Stone {" Seepage Pits: Number Size: x Stone Size: Piping Size Type Builg.irN to tank ham- i , Tank to DritA6ArdeBox t D" x to Field Opening Sealed: N End Cap TN Inlet/Outlet Pipes&Baffles it_ % N Manholes 12"or less below grade �� ✓ � [provide extension collar if Yes] Y V J Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. , Conforms as per Plot Plan Y Engineer Report and As-Built Y 2 N ETU Maintenance Contract _Y_ N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear em Use Stat : Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc