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2004-432 41 TOWN OF QUEENSBURY ^� 742 BayRoad,Queensbury, 12804-5902 (518)761-8201 ow Q rY, Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20040432 Date Issued: Friday, June 18, 2004 This is to certify that work requested to be done as shown by Permit Number P20040432 has been completed. Tax Map Number: 523400-296-006-0001-001-000-0000 Location: 1 MANNIS Rd Owner: RONALD & VALARIE DAVIES Applicant: RONALD & VALARIE DAVIES This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of uil i e Edrc.;(r' rhal TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Verg Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040432 Application Number: A20040432 Tax Map No: 523400-296-006-0001-001-000-0000 Permission is hereby granted to: RONAT,D & VAT,ARTF,DAVIES For property located at: 1 MANNIS 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: RONALD & VALARIE DAVIES 1 MANNIS Rd Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-432 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, June 10, 2005 (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 To ueens ry; u day, June 10, 2004 SIGNED BY for the Town of Queensbury. Director of Building Code nforcement Application for Permit=Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: Or\C` (0; a • Office Use Location of installation: l a-Ai � `/t File Permit No. Tax Map No. / / 1rt Fee Paid Owner's Name: Urt✓ Cc�V� / E Address: (/ A-_0 2. INSTALLER'S NAME : ?` 5` ScP�HONE NO. ZS f• J 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 = Cp 3c C 1980—1991 x 130 gal/bdrm = 1991—present x 110 gal/bdrm = Garbage Grinder Installed yes / no Spa or Hot Tub Installed yes! ./ no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) -14 aphv ature Ground Water Bedrock or Impervious Material Domestic Water Supply Fl sa•- ;teal de depth atpliq#depth municipal 'oiling loam it- N/`�f 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: 7c90e) gallon (min.size 1,000 gal.) rcp(o(G Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s): number of size of each: ft. by ft. Size c 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 Queensbury Sanitary Sewage Disposal Ordinance. hif __ pod gnature of responsible person Date Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: l Queensbury Building& Code Enforcement Arrive: am/pm art: am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: PERMIT NO.: LOCATION: ) COA I 1 S INSPECT ON: filelliffir RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. _ Well separation distance ft. A) a 1 F1—' Other wells: ft. 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/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 Fron Middle Rear System Use Statu : 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 Septic Inspection Report Office No. (518)761-8256 Date Inspection requ t received: /z' Queensbury Building&Code Enforcement Arrive: am/ Depart: V i m/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: `VV NAME: �t\` ,C 1 415 Z� PERMIT NO.: LOCATION: � �y� � INSPECT ON: ra" 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. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: Stone Size: • Piping Size Type Building to tank Tank to Distribution Box CO 8 -rc4 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: A oved rtial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:'\.SueHemingway'J3uilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 it) c4r ii 1101 -41/\ Septic InspectionReport p Re ort Office No. (518) 761-8256 Date Inspection request received: 1 Queensbury Building&Code Enforcement Arrive: am/pm fart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: ,Vl LCI NAME: « ti U i C-_ S PERMIT NO.: LI _ LOCATION: I ( \ c;, r\� l _3 INSPECT ON: - c i RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water (-�J V �eipL 4 C&Ink,E-N Waterline separation distance ft. Well separation distance ft. v,4/ 4-1( Other wells: ft. 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 SipY Type Building to tank 'jDik`3 S' Tank to Distribution Box Distribution Box -ld/Pit Opening Seale.. ' 4/Partial iiiit Location/Separations Foundation to tank 2-0 ft. Foundation to absorption ft. Separation of Pits _ ft. Conforms as per Plot Plan —Y—N Location of System on Property: G / Front ear Left Side Right Side v x /d%- /4LC"7-- D v C.c-I Middle Front Middle Rear /✓A-F r 4-S System Use Status: proved artial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingwayV3uilding.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/pm epart: e am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: -DAV t�''`J PERMIT NO.: ilb f 113 LOCATION: U•&A tuti1 t RC , INSPECT ON: 6 ASV) RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. RC—C1'(C l< C C.-S '" Well separation distance ft. Other wells: ft. Abso stion Field: Total lentth ft. Length of each trench ft. Depth of trenches ft. C-r ;CH /&JLT Size of Stone Seepage Pits: Number _ '`j'c - l'I A- LE Size: x _\ r-� Stone Size: • Pi in Size Type CPL �a R.C.--C-i-eCZK p g 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 Fr n Middle Rear S stem Use Stat • roved artial 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 !. • ' w 7 _ $ ° Tnt7 -,::L...P.---:=7',;,z; i jiRY TOWN OF QUEENSBURY B.U1LDNG DEPARTMENT BUILDIt G & 0 Based on oiir limited mexmaemnitnsation, D T. compliance with our coin icatingshall the not be construed as O REVIEW:. BY - ,.., plans and specifications are in full DATE I a compliance with the Buildtn,,i Codes of New York State. , . 0 00 qui' i 0 /7 IC x pi f,..• J‘ ....y 17 II r U 't....-/