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2005-783 TOWN OF QUEENSBURY 742 Bap Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLI-A-N- CE Permit Number: P20050783 Date Issued: Tuesday, October 11, 2005 This is to certify that work requested to be done as shown by Permit Number P20050783 has been completed. Tax Map Number: 523400-301-013-0002-002-000-0000 Location: 24 BRONK Dr Owner: SUSAN BLAIR Applicant: SUSAN BLAIR 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 '- 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: P20050783 Application Number: A20050783 Tax Map No: 523400-301-013-0002-002-000-0000 Permission is hereby granted to: SIISAN BLAIR For property located at: 24 BRONK Dr 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: SUSAN BLAIR 24 BRONK Dr Septic Alteration Residential Total Value QUEENSBURY, NY 12804-0000 Contractor or Builders Name /Address Electrical Inspection Agency STONE INSTALLATIONS 14 WESTLANDS Ave OIIEENSBIIRY. NY 12804-0000 Plans&Specifications 2005-783 SEPTIC ALTERATION $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, September 29, 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 Town of Queensbury; Thursday, September 29, 2005 SIGNED BY for the Town of Queensbury. hector of Builds &C Enforcement Application for Permit- Septic Disposal System Town of Queensbury 142 Bay Road Queensbun� NY 12804 (518) 761-8256 1. OWNER INFORMATION: ............................................................................................................. _ Office Use Location of installation: �� File Permit No, Tax Map No. / / G / 9 Fee Paid, Owner's Name: ysa&4 ......... ..... .... .. Address: Ve TI Nt 4'f^ 2. INSTALLER'S NAME G �K 4 1/ Ti��a� PHONE NO. 170 7 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 Z or older (31 x 150 gal/bdrm = O �, — 1 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no Spa or Hot Tub Installed yes_ ; no l �fio 4. PARCEL INFORMATION: (circle applicable information& indicate measurements)' T ayhy Soil-Nature Ground Water Bedrock or Impervious Material Domestic Water Supply l sand at what depth at wh t depth municipal Rolling loam 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 Garba Grinder, Spa or Whirlpool Tub. EXr�t/' ;P11 "C4 sf Septic Tank: 00� gallon (min. size 1,000 gal.) Tile Field: each trench�ft. Total System Length: 6j7a.. /evy 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 of the Town of Qu n bury Sanitary Sewage Disposal Ordinance. Z 7 -d��-- Si ature re onsible person Date Town of Queensbury Sewers and Sewage Disposal Chapter Appendix C ABSORPTION FIELD SEPARATION REQUIREMENTS w _ POND 101muL— aK V^VeA- r" rs^rra CIE �`+A�.1311asN Appendix C ABSORPTION FIELD SEPARATION REQUIREMENTS PON SWA--MiL NWT 4 p11f14fL*9oP�t'f y Septic Inspection Report Office No.(518)761-8256 Date Ins ection re est cei d: Queensbury Building&Code Enforcement Arrive: p epart: i 742 Bay Rd., Queensbury,NY 12804 Inspector s Init' Is: NAME: IT NO.: 05- 7 LOCATION: SP CT ON: RECHECK: Comments and/or diagram Soil T Sa Type of a e . Munieip ' ell Water Waterlines aratio ance ft. Well separation distance V7 fl© ft. Other wells: ft. Abso tion Field: Total length Z.vp ft. Length of each trench cv Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Pi in Size Type Building to tank Tank to Distribution Box Distribution Bo eld/P' y t Opening Seal d: artial End Ca 3 fl Location/Separations Foundation to tank ft. Foundation to absorption ft. Se aration of Pits ft. Conforms as per Plot P N Engineer Report an s- uilt Y N Location of System on Property: Front Rear Left Side Right Side Middle Fr �.Rear S stem Use Sta Approved Partial Approved and needs to be re-inspected,please call the Building& Codes Office Disapproved Last revised 1/6/05 i I 4, �0l/./ n��nvrrj I 11 I `! 9 r+u+p trn� bN�sl�� + ,� �. f r 1� r• 'J -t 'l -'�ri�a Vver �C'c oS�(7 r jG►.GGvntn'}' p✓I S►�-E'i � ``� . c.s 7'C"".4c r T"rr-c,. f- .y>*C �.-. or• r„��t� . ��.�of Y ,j C-K, SV$ta (r�� a�Y' �� Lif'ov► K ('t�t 6c"ce cam +0 M C ✓i 5 4-z j l464'►o&.S ��eG•*s 6+��� J+� 4-305 456 518 a 3 0.- 67 c 7 h COP) o �1e`�' Tc 5CitL-e 0100 CSr�r► do p0' p� 5TC ►1-► m n ST a 6► 1 r 2l e c iG f`�c.�C �('GGkS f 1 -3 arc Ae. ed j87' �) BURY TOWN OF QUEENS- PMC,�,Sf S`r�t,C^77 BUILDINGc� �� ,JeH, �„s�� ���c E2EVIEW :G El ; `-- 6� ems ,Z`eo or Rserved, or bellieve I saw evidence of, v,,ells, trees, fences, etc. �h s °,oc? r ,rt, I ,also represent that ( have �. awr=,d ,e r !stances set forth on the diagram.' DATE