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2005-737 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFI CATE OF COMPLIANCE Permit Number: P20050737 Date Issued: Monday, September 26, 2005 This is to certify that work requested to be done as shown by Permit Number P20050737 has been completed. Tax Map Number: 523400-295-010-0001-03 1-00 1-0000 Location: 1085 WEST MT. Rd Owner: GEORGE & JANE LEHMANN TRUSTEES Applicant: GEORGE & JANE LEHMANN TRUSTEES 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 17: J W k- 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: P20050737 Application Number: A20050737 Tax flap No: 523400-295-010-0001-031-001-0000 Permission is hereby granted to: GEORGE & JANE LEHMANN TRUSTEES For property located at: 1085 WEST MT. 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 ' compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: GEORGE& JANE LEIVVIANN TR Septic Alteration Residential 1085 WEST MT. Rd Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET QUEENSBURY, NY Plans&Specifications 2005-737 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 15, 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 wn of Q ens ury; hursday, September 15, 2005 SIGNED dr for the Town of Queensbury. Director of Bud ing&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:b D File Perniit o Tax Map No. Fee Pai Owner's Name: ........................ ...... I.................. ..................................... .......... Address: J— PHONE NO. —Cq9�6 2. INSTALLER'S NAME 7 r,- 1-� 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 y Flow 1980 or older x 150 gallbdrm = 1980- 1991 x 130 gal/bdrm = �/ j 1991 —present x 110 gallbdrm = Garbage Grinder Installed yes no Spa or Hot Tub Installed yes no 4.' PARCEL INFORMATION: (circle applicable information&indicate measurements) Tdooermliv A6154we Ground Water ' Bedrock or impervious Material I ater Su oply rFlat �sand t h i depth at w a epth municipal m et eet MV clay y if well;water supply Steep slope clay %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:�O gallon(min. size 1,000 gal) Tile Field: each trench ft. Total System Length: ft. SeepagePit(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 ofthe 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 o ueensbury Sanitary Sewage Disposal Ordinance. Signature of responsiblfi ptrison' Date flit) vtt of Quemilsbury 5c:+vrt'v and sewstl;c: Dixj oq..t.1 Clinvier 0 Appmulix Co SI:I'ARATIWPJCal Itl�tZI.IIItI'ltill�.l�I'I �s 17t�i POND WELL IN jlt►CX'f,- •' at tt114•1 . G 7 t scr,11c, '� il�tty I . l�y3t?RPtlq 1 7. SICN A.TURE &1 opNIATION FM FuN;s j r.,�>��,�••..,,,..:, � 3 Septic Inspection Rfre Office No.(518)761-8256 Date Inspectio : Queensbury Building&Code Enforcement Arrive: art:742 Bay Rd.,Queensbury,NY 12804 Inspector's InNAME: �F!-� 1Qt DEE LOCATION: gyp i�F� Bj) 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: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial End Caps Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan N Engineer Report a - uilt Y N Location of System on Property: Front Rear Left Side Right Side Middle Fran Middle Rear S stem Use St s• Approved Partial Approved and needs to be re-inspected,please call the Building& Codes Office Disapproved Last revised 1/6/05 Septic Inspection Report Office No.(518)761-8256 Date Inspection re est re ei d: Queensbury Building&Code Enforcement Arrive: m/pm a rt: - in 742 Bay Rd., Queensbury,NY 12804\ Inspector's Initi ls: NAME: P IT NO.: �S"J ' •2 LOCATION: ECT ON: _ !El=1 - cls RECHECK: 121e-- Comments and/or diagram Soil T e: a oam/ Type of • Municipa ell Water Waterline sepa s ance 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: x Stone Size: Piping Size Type Building to tank t �- Tank to Distribution o t� Distribution Box d Pit z Opening Sealed /Pwrflal End Ca Location/Separations Foundation to tank xb ft. Foundation to absorption Separation of Pits Conforms as per Plot P n Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side iddle Fro iddle Rear Svstem se Status: proved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved Last revised 1/6/05 TOWN OF QUEENS y D QUEE NS y BUILDING B , REVIE�NED By DATE— F SEP 1 4 2005 on SIGN .-RE 0 4AT E Qe ;> �Cja)u 30 ()j ---------- ' r t'CA-y c l�-S6 / � til� 9 >