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2007-172 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 (E)w Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20070172 Date Issued: Friday, May 11, 2007 This is to certify that work requested to be done as shown by Permit Number P20070172 has been completed. Tax Map Number. 523400-302-019-0001-027-000-0000 Location: 4 BARBER Ave Owner. H. ROGER & ANN EDWARDS Applicant: H. ROGER& ANN EDWARDS This structure may be occupied as a: Septic Alteration Residential By Order of Town Bowl TOWN OF QUEENSBURY ,s 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 BayRoad, Queensbury, NY 12804-5902 (518) 761-8201 Community Development -Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20070172 Application Number. Tax Map No: 523400-302-019-0001-027-000-0000 Permission is hereby granted to: H. ROGER & ANN EDWARDS For property located at: 4 BARBER Ave A20070172 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. Twe of Construction Value Owner Address: H. ROGER & ANN EDWARDS 4 BARBER Ave QUEENSBURY, NY 12804-0000 Contractor or Builder s Name /Address QUEENSBURY SEWER JAY SWEET Septic Alteration Residential Total Value Electrical Inspection Agency Plans & Specifications -172 CIC ALTERATION RESIDENTIAL $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, Apri123, 2008 (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~wn of ee ~~ ~~ '~;Apri123, 2007 SIGNED BY ~ ~`~~ for the Town of Queensbury. Director of Building & Code Enforcement ' ~~ /}' / ~ "----...OFFICE USE ONLY....._..._._~.._.. . ~ % . .................,.' I •/ f ~~ I I ,TAX MAP N0. ~ ~ PERMIT N0. ERMIT FE ~ ~~ •o~ ~°q''~' APPROVALS: ZONING TOWN CLERK A1'PLICATI """"'""________________________ ~ ,__.~ac~r~ ~,F. ~,~.`y_-.._; UN FOR SEPTIC DISPOSAL SYSTEM PEIZMITBUILaI,~,~~ ,~=^r,~ k`'~"'~Y A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID CO~j" PERMIT. /~ ~~] OWNER: ~ ~`~l~sC- (~--Q(~~~"~~ INSTALLER:~e- ~~~t~1.~,d-VVl' (~ n ~ ~ ,p ~ ADDRESS: / aM~[ ~-P~C- / ! uL.. ADDRESS: ~ ©x PHONE NOS. PHONE NOS. ~ ~ ~~ LOCATION OF INSTALLATION: - - .......................................r...........~ ,...............................................,,........................ YEAR BUILT X COMPUTATION= RESIDE INFORMATION .»...........» ................................ ..BEDROOMS I I = ~ TOT ' DAILY FLOW » .......................... ................................................................ ~ AL 9 p ......... ... 1980 or older ~~•~~ ~ ~~ X 150 allon er bedroom `~~~~~ ~~~~ ~~~~~~~~~ ~~~~~~~~~~~~•~~~~~•~~~"~~~~~~~~~~~~~ .. .. ........................................................... g p I ~~ NSTALL~EDQR 1981 -1991 { ..........}..........~ ................................................ i X 130 allon er bedroom ~ i ~~~~ .. . ~ ......................................................... i AORH 1992 -present ~ a ...................................................................................... OT TUBt .-v~ X 110 gallon per bedroom l : -.~_ ..............»............................... ..................,............... .........................................,...............................I...........r...................,.....,.......... INSTALLED? PARCEL INFORMATION: / TOPOGRAPHY: FLAT R LLING~EEP SLOPE %SLOPE / ,SOIL NATURE: SAND LOAM CLAY OTHER / GF~,OUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH / DOMESTIC WATER SUPLY: MUNICIPAL ELL (IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. / PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (TEST TO BE COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITECT) 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 lea h fi for each garbage grinder, spa or whirlpool tub. / SEPTIC TANK:~~~ I , S~E IS 1,000 G-/~ TIL~ L .EACH TRENCH F T. / TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY? / SIZE OF EACH FT FT. / IZE F TONE T BE . # /DEPTH OR THICKNESS FT. / BED SYSTEM SIZE: X / ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE / HOLDING TANK SYSTEM: (If required) N0.OF TANKS: /S/ZE OF EACH / GALLONS. /TOTAL CAPACITY.• GAL. NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK.MUST BE INSPECTED BY~A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 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 QUESTIONS ? CALL 761-8256 OR EMAIL u itary Sewage D' osal Ordinanc codes~aueensb ,ry, net VISIT OUR WEBSITE FOR MORE INFORMATION ~~ www.gueenaburv et nature arson Responsible ate Town of Queensbury • Community Development Office • 742 Bay Road, Q>-ceensbury NY 12804 ~9 Septic Inspection Report Office No. (518) 761-8256 Date Insp~ction~equest~receDivee~da: Queensbury Building & Code Enforcement Arrive: Z. o_Y am/q~rZ~ _ rt: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: ~ PERMIT NO.: ~~_ ~ ~~ LOCATION: INSPECT ON: RECHECK: Soil T :Sand Loam Cla T of Water: Munici 1 Well Water Waterline se ration distance ft• Weil separation distance Other wells: ft• ft. Abso flan Field: Total len h ft. of Bch trench ft. of trenches ft• Size of Stone See Pits: Number Size• x Stone Size• Pi l Siz T Buildi to tank Tank to Distribution Box H Distribution Box to Field Pit 0 ni Sea~d: Y N Partial End Ca Inl Outlet Pi & Baffles Y N Location Se rations Foundation bo tank ft• Foundation to abso ion ft• Se ration of Pits ft• Conforms as r Plot Ptan Y N E ineer Re rt and As-Built Y N Location of Sy on Property: Front Rea Left Side Right Side Middle Front Middle Rear Comments and/ot diagram d.vLt~ ~ed~~ system Use Stat Approved Partial Approved and needs to be re-inspected, please call the Building & Codes Office Disapproved Last revised 021006 Last revised 1/6/05 ~o v€~ ~~ ~N © /ooo ~' Q~ i Lc, r~ ,~tS..:~..+~ ~OV1i~ ~ - .~'- F ~ ~ ~° r . . --`~`; _ ~ '}. - /IN -.f s ` `' ° ~ =r, _. ; z. :; :~ _`~ ' ~ P 7'•~ y Y J 'T1 -~.-. jA in ~i -, ~ r ~I ~~ ~`3 ~~~ ~,~~ ~~ ~ r~ sa ~ L +? ,~. + ' r'1 ~ -G ^ '~