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2004-273 = 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: P20040273 Date Issued: Thursday, May 06, 2004 This is to certify that work requested to be done as shown by Permit Number P20040273 has been completed. Tax Map:Number: 523400-295-018-0001-059-000-0000 Location: 23 KILEY Ln Owner: STEVEN & EILEEN SOPRANO Applicant: -STEVEN&EILEEN SOPRANO This structure may be occupied as a: By Order of Town Board Septic Alteration Residential of EE sB (74 Director of Building&Code Enforcement 1"-'� ., TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040273 Application Number: A20040273 Tax Map No: 523400-295-018-0001-059-000-0000 Permission is hereby granted to: STF,VF,N&F,II,F,F,N SOPRANO For property located at: 23 KILEY 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: STEVEN&EILEEN SOPRANO 23 KII.,EY Ln Septic Alteration Residential Total Value QUEENSBURY,NY .12804 Contractor or Builder's Name/Address Electrical Inspection Agency STTNORELLi& SON 589 WEST MOUNTAIN ROAD OI TEENSBi TRY_ NY Plans&Specifications 2004-273 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,May 04, 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 Tow ueensb s y,May 04, 2004 SIGNED BY for the Town of Queensbury. Director of Building& ode Enforcement Applic>atiorl for I'crrllit —Septic Disposal Systelt, k) wl (if Q1leensbUl y 742 Drry Karin Queensbuty, NY 12804 (318) 761-8236 1, OWNER INFORMATION: ' ........................................................................... Office Use Location of installation: Of 3et'lif Tax Map No. / / Kilo I'onttit No. (� Foo Paid aS G �b Owner's Namo; �J c�.p�� !U O nn ........................................................................................................I............. .,...,.,. Address:_ t7� l �L° L/*UJe— ( 2. 'INSTALLER'S NAME PHONE NO. 7� `/s'O O 3, RESIDENCE INFORMATION: (circle year of dwelling, indicate 11 bedroom(s)and multiply# o,f bedrooms with applicable gallons per bedroom to equal total daily flo)1) ear of HQUSe' No of Bodrouis x QQM 11 tivit__= _ _TOal-Daily Flo 1980 or older _ x 150 gal/bdrnt - 1980— 1991 x 130 al/bdrm = 1991 —present x 110 gal/bdrm — u' ; r ✓,�G���`l Garbage Grinder Installed yes / no Spa or Whirlpool Installed yes / no 4. PARCEL INFORMATION: (circlo applicable information & indicate measurements) 71i? Way. tiLt,V__ . .Q.(Qvild.Wittrr.salm rrl whirl tielpth rr1 whal(lepilr rn►,►rlcFin?'orun --filet _ y Steep slope clay !/'►veil; water supply slope other from any septic-system depth: absorption is fl. other Porcolation Test: (To be completed by 11censed pro fesslonal engineer or architect) Ila1e; ininute per itch S, PROPOSED SYSTEM: For Netr Construction: All Individual sewage disposal systems must be designed by h licensed profcssiottal engineer or arclikecl (unless Installed in a i'Ianoinl;llaaid all7rowd sulAivision). Add 250 gallons to the size of(lie septic Ivtk and leach lield for each Q'Ilbage(►tinder, Slia or Whillix►ol Tub. Septic'Tank. gallon (min. size 1,000 gal.) Tilo Field; each trench f?. Total System Length: fl. Seepago Pit(s): number of size of each: __,fl. by ft. Size of Stone to be timed: ll / Ckp/h or Bed System Size; x . Altomative S stom: /L% r'o2� y� `N�i length and/orsize _ - 6, HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /•TOTAL Capacity: gallons Note: Alann System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON 0)leaso read) For your protection, vlonse noto flint pursunnt to Section 136-29 of tiro Codo of tho Town orQuoonsbtn-y, nay porrrrit or npprovni granted which is bnsod upon or is grnntctt it, reliance upon any rnatorial nrisrcliresantation or G-filure to make a rrratcrial fact or circurustnnco known by or on bclrnirornn applicant, strati bo void• I have rand tho rogutntions with respect to this nppllcntion and ngree to abido by Iltoso and nil roquirontonts of Oro Town of Queensbury Sanitary sewago Disposal ordinance. Sig ure of r ponslble person Date Septic Inspection Report Office No. (518) 761-8256 Date Inspection requ t received: Queensbury Building&Code Enforcement Arrive: am/� epart: am/pm 742 Bay Rd., Queensbuly,NY 1,2804 Inspector's Initials, NAME: et-l— -2�7�5 Calf 9,IS.P 0 PERMIT NO.: LOCATION: INSPECT ON: S` eo RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. , _ O Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. b N L Depth of trenches ft. Size of Stone -Seepage Pits: Number /Size: 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: Front Rear Left Side Right Side Middle Front Middle Rear _System Use Status: A roved rtial Approved and needs to be re-inspected,please call the Building&Codes Office isapproved L:\.SueHemingway\Building.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: am/ part: - am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: e tilp PERMIT NO.: LOCATION: l - INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. � _ (,Z� (� A r- Well separation distance ft. rJ I v r 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 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 Front 'ddle Rear System Use Statu . Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 - 330 Septic Inspection Report Ott f Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: an p Depart: - - , am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initial NAME: PERMIT NO.: / C>I- fll� LOCATION:_ \ ��,�� INSPECT ON: `�' —0 RECHECK: � J Comments and/or diagram Soil Type. Sa Clay Type of Water Municig/Well Water Waterline separ istance _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 D Seepage Pits: Number Size: x Stone Size: Piping Size T e Building to tank `i oi3 Tank to Distribution Box Distribution Boy/,to Neld/Pit `� H Opening Seale A- Y 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 Front Middle Rear _System Use Status: Xarpproved tial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 TOWN OF QUEENS6URY BUILDING DEPARTMENT C2 713- Based on odr limited examination, compliance with our coin�ntints shall not be construed as indloating the t plans and specificotians rare in full compliance with the Building Codes of New York State. > © BUILDING & LU © 75 REVIEWED BY L s 0 G DATE UJ j '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 personally measured the istances set forth on the diagram." � �/-ay IGNA U, DATE } ICE le � � � �,�