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2005-717 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 (zt Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20050717 Date Issued: Thursday, August 26, 2010 This is to certify that work requested to be done as shown by Permit Number P20050717 has been completed. Tax Map Number. 523400-226-019-0001-082-000-0000 Location: 226 LAKE Pky Owner. JASON MAYNARD Applicant: JASON MAYNARD This structure maybe occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, y �`r Variance, or other issues and conditions as a result of approvals by the Director of Building&Code VInforcefflent 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: P20050717 Application Number: A20050717 Tax Map No: 523400-226-019-0001-082-000-0000 Permission is hereby granted to: JASON MAYNARD For property located at: 226 LAKE Pky 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: JASON MAYNARD Septic Alteration Residential ATTN: DEBORAH CARUSO Total value 27 OAKVIEW Dr FT. EDWARD, NY 12828-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2005-717 SEPTIC ALTERATION $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, September 22, 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 To of Quee bury; Th rsday, September 22, 2005 //SIGNED BY t, for the Town of Queensbury. Director of Buildin &Co e Enforcement Application for Permit.—Septic Disposal System 7Own of Queensbiti)► 7•121.1u3llluurl Qrieenshiu.v, NF 12804 (:518) 701-8256 4j pl;k 1. OWNER INFORMATION: , 226 Lake Parkway Off c Use 's Location of installation: Assembly Point i Tax Map No. 226/.19 1 / 82 File Pennit No. � 00 Fee Paid Owner's Name: Jason Maynard Address: 248 Sly Pond Road a��, Fort Ann, NY 12827 2. INSTALLER'S NAME PHONE NO 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate JJ bedroont(s) and multiply It of bedrooms with applicable gallons per beth•oom to equal total daily./loll) Year of House: No. of Bedrooms x Computatio❑ = Total Dah Flow 1980 or older x 150 gal/bdrut = _ 1980— 1991 x 130 gal/bdrm = 1991 —present 5 x 110 gal/bdrm = 550 r Garbage Grinder Installed yes_ / no X Spa or Whirlpool Installed yes_ / no X 4. PARCEL INFORMATION: (circle applicable inforntatiob &indicate measurements) SEE PLANS Top�g1�tll►y Sgil Bedrock or_Impervious_Material_._Donip tic._Walcr Supply . 1,7at strnd at whal depth al what depth municipal Rolling lotun feet feel well Steep slope clay if well; water supply _%slope other from any septic-systern depth: absorption is ft. other_ Percolation Test: (7 o be completed by licensed professional engineer or architect) Kate: minute per inch - - SEE PLANS 5. PROPOSED SYSTEM: For Ne`v Construction: All individual sewage disposal systems nuts(be designed by a licensed professional engineer or architect(unless installed in a [laming 13oard approved subdivision). Add 250 gallons to the size of the septic lank and leach field for each Garbage Grinder,Spa or Whirlpool Tub. Septic Tank: 1500 gallon (min. size 1,000 gal) SEE PLANS �► � �pQr� Tile Field: each trench _f1. Total System Length: Seepage Pit(s): number of size of each: ft. by ft. Sizo of Stono to bo used: 11 / depth or thickness fret 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 noto 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 au applicant, shall be void. I have read tho regulations with respect to this application and agree to abide by these and all requirements of the own f Queensbury Sanitary Sewage Disposal Ordinance. 9205 Signature f responsible person lbate Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials. �y j NAME: PERMIT NO.: ,�`� 7/ LOCATION: INSPECT ON: ._ RECHECK: Comments and/or diagram Soil Type: Sand Loam/ Clay �* T of Water: Municipal Well Water � , 2 2 _ C 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 N 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. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built _Y_N �� � ETU Maintenance Contract Y N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear stem Use S us: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspecbon Forms\Septic Inspection Report`03 2910.doc Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: NJPERMIT NO.: � ! LOCATION: INSPECT ON: RECHECK: Comments and/or diagram Soil T : Sand I Loam/Clay - - - Typ2 of Water: Munici I/Well Water Waterline separation distance Well separation distance ft. Other wells: ft. Absorption Field: Total len ft. Length of each trench ft. Depth of trenches ft. Size of Stone See 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 End Ca Inlet/Outlet Pipes&Baffles Y N Location/ Separations t� Foundation to tank ft. Foundation to absorption ft. Separation of Pits Conforms as per Plot Plan Y N Engineer Report and As-Built Y N OV L Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status roved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 Septic Inspection Report Office No. (518) 761-8256 Date Ins y�on request received: Queensbury Building&Code Enforcement Arrive: ( am/ Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: V NAME: i1w '" PERMIT NO.: LOCATION: INSPECT ON: RECHECK: Comments and/or diagram Soli T : Sand Loam/Clay Type of Water: Municipal/ Well Water i1 j Waterline separation distance ft Well separation distance ft Other wells: ft, Absorption Field: Total lengthft, 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 Feld Pit Opening Sealed: Y NI Partial End Ca r In Outlet Pipes&Baffles Y N J Location Se rations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N En ineer Re rt and As-Built 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 Last revised 021006 Last revised 1/6/05 Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: �- am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: f. 0 NAME: PERMIT NO.: LOCATION: INSPECT ON: RECHECK: 05�- 776E Comments and/or diagram Soil Type: Sa Loam/Cla - Type of Water: Municipal/Well Water Waterline se ration distance ft. Well separation distan ' , Other wells: Absar on Field: Total lengLh ft. ��� Length of each trench ft. � Depth of trenches ft. Size of Stone Seepaqe Pits: Number Size: X Stone Size: Piping Size T Building to tank Tank to Distribution BOX Ate- Distribution Box 'eld Pit 41, Opening Sealed:C2141 Pa "al End Ca In Outlet Pipes&Baffles Y N Location ation Separations r t� Foundation to Foundation to absorption Separation of Pits ft. Conforms as r Plot Plan Y N `� Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side (2--L Middle Front iddle Rear Approved Partial Approved and needs to be reinspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05