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2004-040 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: P20040040 Date Issued: Thursday, March 11, 2004 This is to certify that work requested to be done as shown by Permit Number P20040040 has been completed. Tax Map Number: 523400-302-005-0001-034-000-0000 Location: 5 JUNE Dr Owner: DORIS MULLIS Applicant: DORIS MULLIS This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040040 Application Number: A20040040 Tax Map No: 523400-302-005-0001-034-000-0000 Permission is hereby granted to: TORTS MI Tf,T,TS For property located at: 5 JUNE 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: DORIS MULLIS Septic Alteration Residential 5 JUNE Dr Total Value QUEENSBURY, NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency TNT EXCAVATION 857-8531 NY 00000-0000 Plans&Specifications 2004-040 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, March 09, 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 own o Queeti�b sd , March 09, 2004wn o the To Queensbury.SIGNED BY for f Q n ury. Director of Building&Code Enforcement Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: 3-;ej am/pm Depart: am/pni 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: �� PERMIT NO.: 0LI' `ry LOCATION: INSPECT ON: /i U 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 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 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: ''iron. Rear Left Side Right Side Middle Front Middle Rear System Use-Status: V Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingwaylBuilding.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: 113 , am/pm Depart: a p 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: �.i PERMIT NO.: — O�/U LOCATION: , - INSPECT ON: 3 //U 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. T �J� Length of each trench ft. Depth of trenches ft. ^J lz 1 Size of Stone Seepage Pits: Number Size: x Stone Size: 2 �' 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 Foundation to absorption ZD ft. Separation of Pits /6 ft. Conforms as per Plot Plan Y N Location of System on Property: gion 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 LASueHemingway\Building.Codes.Inspection.FORMSLSeptic Inspection Report.doc January 28,2003 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: File Permit Tax Map No. Fee Paid a �� Owner's Name: 00 `• ....................................................... Address: ........�J��=�` ,. ... ...,..... INSTALLER'S NAME s� c ti � PHONE NO. 2 � �x�� 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 gallbdrm = 1991 —present x 110 gal/bdrm = r Garbage Grinder Installed yes_ / no tAC:US' ` �® Spa or Hot Tub Installed yes_ ./ no r j 1 2004 TOWN EENSBURy 4: PARCEL INFORMATION: (circle applicable information&indicate measureme t I ILDlNG AND CQDE CODE Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Sunnly Flat sand at what depth at what 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 Garbage Grinder,Spa or Whirlpool Tub. Septic Tank: lJ�d gallon(min. size 1,000 gal) AAA Tile Field: each trench ft. Total System Length: fl. Seepage Pit(s): number of c2— size of each: 60 ft. by ft. 2— 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 r gulations wit re pect to this application and agree to abide by these and all requirements of e Town of ee sbury Sanitary Sewage Disposal Ord' ance Sign atur of res onsible person ate \Ill • 1 • .7,owil of Qlleollabul•y Sq.%vcl•s and 4cws),.e Disposal (:llsiplel• • AIspondi x A11.40RV-110N. I,Il,l.1I.) • 9- PA"A RATION RSIQU i RIVI I itsN'l"S V41V-LL iN jihr,.•R• rt �t•w•� . . •rK+�ur C�t•tC; ram... ,•- . „ c•Pav. ,/ rr•A ,r,r ue,turn.,1III f ' F�tial� 7. Sl( IN TURF &INFORMATION FOR I��YV�+�JksL�x►�s�cWv;� u„ea....�...y LOT # 12 LOT 12'-5" --{ 1 3'—4" EXIST. 1 CAR _ 5" GAR. Lo 38'— 10" LO N EXISTING N 3 BEDROOM 21 '-7" HOUSE Leachfield system :' e ; , replacement only, ° �rxY existing septic tank to Sul EP.�.. remain, withen offsets ;,;,�, << 4�, 18"—8" 3 6'— 10" I indicated. _ � I 2 - 800 Gallon Dry wellsTE.- �^ y I (6' dia. x 8' deep) ti be I 30' used. Dry well to be surounded by a 2 " Gravel bed. 10' li 49'—6" 15' I W 1 6' Z I 22' II W Ld � Iz F- I 15' lU) 100 ' ; < Ed e of Pavement I I JUNE D P� SITE PLAN.DWG _` 1VE 3-08-04