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2004-218 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: P20040218 Date Issued: Tuesday, April 27, 2004 This is to certify that work requested to be done as shown by Permit Number P20040218 has.been completed. Tax Map Number: 523400-301-006-0002-047-000-0000 Location: 30 SWEETBRIAR Ln Owner: ROBERY LEWIS Applicant: ROBERY LEWIS This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement y A TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040218 Application Number: A20040218 Tax Map No: 523400-301-006-0002-047-000-0000 Permission is hereby granted to: ROBERY LEWTS For property located at: 30 SWEETBRIAR ,Ln 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: ROBERY LEWIS CYNTHIA CARTIER-LEWIS Septic Alteration Residential Total Value 30 SWEETBRIAR Ln QUEENSBURY, NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency I Plans&Specifications 2004-218 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 22, 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 Tp�wn o �/ f April 22, 2004 ueen 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 (518) 761-8256 1. OWNER INFORMATION: :......................................................................................................... c�� Office Use Location of installation: �Q J �'l !� Y,'1 01 File Permit No. Tax Map No. OD Fee Paid c 1' Owner's Name: ..............................................................................................,,....,........... ,.,...,.,,.,.......... Address: 2-1, �GI/c'G� (�l �� LIV J 2. INSTALLER'S NAME 60 S �� �1� 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 = 19 9.1-present x 110 gal/bdrm = Garbage Grinder Installed yes i / no 2 Spa or Hot Tub Installed yes ./ no QUEEr�SgUEY - :4: PARCEL INFORMATION: (circle applicable information&indicate measurements) 1T0*NUZ-�- 61 ©� 6 C'00 TpRogrgphy Soil Nature Ground Water Bedrock or Im ervious Material Domestic Water Su ply Flat sa at what depth at what depth _municipa Rolling loam feet feet we Steep slope clay if well; water supply slope other from any septic-system depth: absorption is_I 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. gallon (min. size 1,000 gat) 3�`�� Tile Field: each trench ft. Total System Length: l Seepage.Pit(s): number of r size of each: B 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: o of Quee rSamtaSe. age Disposal Ordi7 � nature of responsible pers n - Date :7,o vlt UY Que-ellabtli-Y St;�vc:r� ;ltl(1 '40W gi-- 1)i:sjmmstl (:llsljti(•:• . 1 Islsr uli x t • AIII.-SO LI'''t11 N. I-111;1.01.) ' SI:I'/I1tA'1'iW1N li:I;6�t.311tI�h]I�:i�'I`;i ' 00, ..�. _ �� Rear^g �'F-,n• A�y'rpitPtK11 F`t qL.D 7, SIGNA►'1:'LJRE &INFORMATION FM MSj'QN;SAOLr,�zr,,3v�.-1 WLva-b�•w�►�; R Septic Inspection Report - Office No. (518)761-8256 Date Inspection r uest e qepartTa��Mga Queensbury Building&Code Enforcement Arrive: am/p �pim. 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia II Q NAME: P IT NO.: ``t' Q O LOCATION: SPECT ON: RECHECK: Comments and/or diagram Soil T San Clay T e of ti er: unicipal Well Water Waterline separ tion ante _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: Pi-pinLy Size Type Building to tank Tank to Distribution Box Distribution Box t iel Pit 't Opening Sealed: i /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: Front Rear Left Side Right Side Middle Fr on •ddle Rear System s• Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LasueHemingwaylDuilding.Codes.Inspection.FORMS\Septic Inspection Report.doe January 28,2003 Robert Lewis Septic System Page 1 of 1 Robert Lewis Septic System 7v^' t " t,Y l.J _ LU I'3 301:6247. �P. [L. o . 301,6-2-23 �� ..,,,.,:... j4 •, iji 2 jjk uj Q ........................................ 2 T - acalebar;lenOth alwaga=300feet G� LI-,-lZ Town of Queensbury 742 Bay Road Queensbury,NY. 12804-5902 APR 2 2 �p04 TONNN OF Q SF6 CODE- �� IN "I have seen or observed,or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., shown on this document. I also represent that I have ' stances thediagram." �` �' :iiy, : , �, I✓ Jit�person easured the di set forth on I"� i1 �iSian es Set � a��a � �� SIGNATURES SIGNATURE DATE DATE http://gby2svr/gis/printdis.asp 4/22/2004