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2005-940 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20050940 Date Issued: Tuesday, December 13, 2005 This is to certify that work requested to be done as shown by Permit Number P20050940 has been completed. Tax Map Number: 523400-309-015-0001-053-000-0000 Location: 216 FIFTH St EXT Owner: JAMES AIKEN Applicant: JAMES AIKEN 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: P20050940 Application Number: A20050940 Tax Map No: 523400-309-015-0001-053-000-0000 Permission is hereby granted to: JAMES AIKEN For property located at: 216 FIFTH St EXT 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. Tyne of Construction Value Owner Address: JAWS AIKEN HEATHER SORENSEN-AIKEN Septic Alteration Residential CAROL SORENSEN Total Value 218 FIFTH ST. QUEENSBURY, NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET QUEENSBURY, NY Plans&Specifications 2005-940 SEPTIC ALTERATION $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday, December 12, 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 n of eens n y, December 12, 2005 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury, NY 12804 (5I8) 761-8256 1. OWNER INFORMATION: ..................................................................................i 5 %i� 6"Xoffice use Location of installation: )J � c Q Tax Map No. File Permit No. / / c Fee Paid J 0 1�) Owner's Name: d /i G AiLA-1 Address: — 30 1 4 1� i 1 C 2. 'INSTALLER'S NAME . I > ; PHONE NO. 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 = 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = u �a � ----- � Garbage Grinder Installed yes— / no E Spa or Whirlpool Installed yes— / no DEC 12 2005 sBURY 4. PARCEL INFORMATION: (circle applicable information &indicate measuremen s) 'U��G��COPE r , ur Ground Water Bedrock or Impervious Material mes i er Supper: Elat sand at what depth at what depth nrt�nicipa! oiling m feet feet 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: /a0 a . gallon(min. size ],000 gal.) Tile Field: each trench _ft. Total System Length: f1. Seepage Pit(s): number of size of each: fl. by ft. Size of Stone to be used �d,4epth 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 l 36-29 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. f� _,oe _,^. Signature of responsible person Date Septic Inspection Report i Office No.(518)761-8256 Date Ins ection r uest e eiv ' r�. — Queensbury Building&Code Enforcement Arrive: arn/pii epart: <;am/ 742 Bay Rd., Queensbury,NY 12804 Inspector's In' I NAME: ---N P IT NO.: ��!7--� RECHECK 11 �,l4 `�� T a I I1��PECT ON: 17 �F.C-V\ 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 Y N Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Font Middle Rear System Use St4tus: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Last revised 116105 Septic Inspection Report e, Office No. (518) 761-8256 Date Ins ection re/q es 'ec ve Queensbury Building&Code Enforcement Arrive: pom part: _ pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi Is- NAME: ,i , 1-y�S-w � ��, P 'RrMI'T NO.: LOCATION: SPECT ON: RECHECK: Comments and/or diagram Soil Type: and Loam_/Clay Type of Water: gunicipal%Well Water Waterline separation distance Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench Zft. Depth of trenches Size of Stone seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box a Distribution Box to Field/Pit o Opening Sealed /Partial End Caps Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft. 1396Y,cK) L31`A Conforms as per Plot Plan N Y N Engineer Report and As-Built Y N '�-� Location of System on Property: Front Rear Left Side Right Side Middle Fro CtLid le�Rear System Use Status- Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved Last revised 1/6/05 RECEIVED DEC ? 2 2005 TOtfN,OF-QUEENSOURY --=uiLDIP G AND Cam_ v � 1 1 TOWN OF Off. NS Y BUILDING �O�F `� T• d >tIG� REVIEWED L`.' ' L �-o d l Da �'�` DATE___�_�;✓ �--t Z� v 16 S `� 57 X� "' seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, tc., shorn on this document, I also represent that I ave persona f ineasured the d"stances set forth on tie diagram." v SI NA UR.E DA'i E