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2004-291 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: -P20040291 :- .Date Issued: Tuesday, May 18, 2004 - This.is.-to certify that:work requestedto-be done as:shown by.Permit Number has been completed. _ Tax Map Number: 523400-302-014-0001-076-000-0000 Location: 8 BENTLEY PI Owner: CE RISTOPBER&DENISE ROUND Applicant: CE RISTOPBER&DENISE ROUND 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: P20040291 Application Number: A20040291 Tax Map No: 523400-302-014-0001-076-000-0000 Permission is hereby granted to: CHRTSTOPHF,R &DENISE ROT TND .For property located at: 8 BENT'LEY Pl 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: CERISTOPBER&DENISE ROUN 8 BENTLEY PI Septic Alteration Residential Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency T.B_S. SEPTIC 2 LOWER WARREN STREET OT TEENSBI TRY_ NY Plans&Specifications 2004-291 SEPTIC ALTERATION $25.00 PERMIT FEE PAID.-THIS PERMIT EXPIRES: Thursday, May 12, 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 T(� Quee ury n ay,May 12, 2004 Queensbury. SIGNED BY ` for the Town of _ 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: Office of installation: i Use 'ce r- File Permit No. Tax Map No.K7,I ql / ,o I Owner's Name: I.VVY f't �(�U�� Fee Paid ........................................................................................................................................ Address: 2. INSTALLER'S NAME U�p�q� ��w l � PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#o bedrooms with applicable gallons per bedroom to equal total dc . o ) EIVED Year of House: No. of Bedrooms x Computation = Total Daily Flow jitA Y 10 2004 1980 or older x 150 gal/bdrm = T^WN OF OIIEENSBURY 1980-1991 x 130 gal/bdrm = UlLni,�� D 1991 -present 4 x 110 gal/bdrm = Garbage Grinder Installed yes_ / no `� © �<< we�v Kaki.-Swt �1 4 1r-5: GnAf-U-Cf Spa or Hot Tub Installed yes_ ./ no ✓ 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) ographv Soil Nature Ground Water Bedrock or Impervious Material Dome tic Water Supply WFlat �!V at what depth at what depth _municipal > G,� feet > feet w—ZZ 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: - A=<* 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 gal) Tile Field: each trench ft. Total System Length:_ ` f. �4X90)alr(5x4o ) Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: #_Z / depth or thickness feet i Bed System Size: x Alternative System: length anld/or size 6. HOLDING TANK SYSTEM: (if required) �(J 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. y 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 Queensbury Sanitary Sewage Disposal Ordinance. b \ Sig ature of responsible person Date 1 5� Appondix C, ✓ AI4.SUMI'VION FIELD SI'PARA'1'IO N 1*11 t. RIVIN110PNIS IoNr • 1 1-77' G ✓ (\ .... ` ���,,•., I U1511Ip,.I)fit%II ' M�K 1 r 7. SIGNATURE &INFORIvMATION FOR-US'LINSI sLZ rnx'%Z•,;'4 wl---.•%+.wi Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/p part: - am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: N PERMIT NO.: 0 2 LOCATION: INSPECT ON: 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. 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 Fro Middle Rear S stem Use Stat s• Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:1SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 i Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: ` Queensbury Building&Code Enforcement Arrive: am/ ,epart: _am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: PERMIT NO.: � LOCATION: INSPECT ON: - r RECHECK: Comments and/or diagram Soil Type: a ' / ay Type of Water: Ounicipal/ ell Water Waterline separat nce 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 AI ��G� PC—C r� Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box Field/Pit & Opening Sealed Y/N/Partial Location/Separations Foundation to tank -ft. Foundation to absorption t. Separation of Pits ft. Conforms as per Plot Plan Y N Location of Sys m on Property: Vd /UO f �UCH Front Rear Left Side Right Side Middle Front Middle Rear System Use!;Disapproved s: -oved artial Approved and needs to be re-inspected,please call the Building&Codes Office L:1SueHemingway\Building.Codes.[nspection.FORMS\Septic Inspection Report.doc January 28,2003 J A ' 60i l IIjIiIiiI!I�jiIiiIji!�---- {IIIIj�t�IIfjIijI'I`��I!ijtII�IjIIII��--� �Ij�i� --,-��i��1iIIiIIIiI,-'l--�I'I`III�IIIIIII�,IIi j l`-�Aa--l iiIii��iii�i�IiI L L I A �-i,IIi;'IIII��I_�°-�'--,�Ii'�'�'dI IiI, L L Ca t- A TIN i J- _-T j EC.,I 004 Mi AY 1 0 2 _-"NSBURYi TOWN 0 -CLIU- E C) i -T I -J. I have:seen or observed, or beli6ve I sa�w evidence of 1 1 1 1 : I , I I I :es etc)a)I objects such as hbuses,;wells, trees, fen shown on fllis!doibument. I-also represent 6at ve I hal !measured the distances set forth on the diagram. 1 A i ers 6q-- 0 1.. 01 sI'GNATIJIRE DASE REVIEWED B BUILDING &' -A �F F E >71.4 ��Fil I DATE 77