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2007-273 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. P20070273 Date Issued: Wednesday, May 23, 2007 This is to certify that work requested to be done as shown by Permit Number P20070273 has been completed. Tax Map Number. 523400-296-014-0001-005-000-0000 Location: 94 MONTRAY Rd Owner. JAY & PATRICIA MAYER Applicant: JAY & PATRICIA MAYER This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY . . / Issuance of this Certificate of Compliance DOES NOT relieve the / property owner of the responsibility for compliance with Site Plan, �F 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 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20070273 Application Number. A20070273 Tax Map No: 523400-296-014-0001-005-000-0000 Permission is hereby granted to: JAY&PATRICIA MAYER For property located at: 94 MONTRAY Rd 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. Tvpe of Construction Value Owner Address: JAY&PATRICIA MAYER 94 MONTRAY Rd Septic Alteration Residential QUEENSBURY, NY 12804 Total Value Contractor or Builders Name/Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans &Specifications 2007-273 SEPTIC ALTERATION RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,May 14,2008 (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 To of Qu nsb IVgt:.3Uy 14, 2007 SIGNED BY ` for the Town of Queensbury. Director of Building&Code Enforcement /_ OFFICE USE ONLY % / TAX MAP NO. PERMIT NO._(/�1� �ERMIT FEE ', / , APPROVALS: ZONING TOWN CLERK ; 0 TOVvn, t a 0RY 0,,,,I� BUILDING AND CODE APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJE O REVIEW BEFORE ISSU CE OF A VALID PERMIT. OWNE _ INSTALLER: I flG� ` ADDRESS: / l I ��y 1�"✓/ ADDRESS: #0 0 U D3( PHONE NOS. PHONE NOS.Z 96 — 0 �c LOCATION OF INSTALLATION: ............................................................................................'................................... .................................................`.... . . . RESIDENCE INFORMATION: NO.OF 3 ............................................................................ ESID YEAR BUILT '• X I COMPUTATION= i TOTAL DAILY FLOW BEDROOMS i ........................... ......................,......................................................................,,.....,......;..................... .... .... ............................................ GARBAGEGRIN 1980 or older X 150 gallon per bedroom = i ( INSTALLED? .............................................................. ......................................... ...................................................................... .... 1981 1991 X 130 gallon per bedroom 1 = SPA OR HOT TUB »..............................................................................................................................................................................:........................................................................... a 1992-present 1 X 110 gallon per bedroom I INSTALLED? ................................................................................................................................................................................................................................. PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT RO LING ' STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL " WELL (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 leach field for each garbage grinder, spa or whirlpool tub. ✓ SEPTIC TANK:P� GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT. ✓ TOTAL SYSTEM LENGTH: ?"�j FT. SEEPAGE PIT(S): HOW MANY? WI,A- ✓ SIZE OF EACH FT. X FT. ✓ SIZE OF STONE TO BE USED: # '21— /DEPTH OR THICKNESS f2_-FT. ✓ BED SYSTEM SIZE: X ✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE ✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH ✓ GALLONS./TOTAL CAPACITY.• GAL. ..................................:.....:.:.:.........................................................:...:...:.:...:.........:...:......................................... .... ..:. . NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN 1i APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. I. ii....................................................:.:.......:.....................:.:...:•:•i.:.....:..:.:.:.:...........�.:•�•..:.:�:.�:.:.:.:....:�.. : : i 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 thes d all requirements of the Town ofC1Q1UE:STIONS? CALL 761-8266 OR EMAILbury Sanitary ew a Disposal Ordinance. codes�aueensburv.netEBSITE FOR MORE INFORMATION T/I www.aueenaburv.net Ign ure of Person ponsible Date r Town of Queensbury ■ Community Development Office ■ 742 Bay Road, Queensbury, NY 12804 19/o Septic Inspection Report Office No. (518)761-8256 Date Inspectio Queensbury Building &Code Enforcement Arrive: a p • . 1.�a 742 Bay Rd., Queensbury,JJNJ�,,Y 12804 Inspector's In NAME: /��a�1►�2 • & P R NO.: LOCATION: _ I CT ON: 7 1 RECHECK: l Soil Tyt Sand lay _ Comment /or diaoraM Type of unici ell Water Waterline sepa nce Well separation distance ft, Other wells: ft, Absorption Field: Total length ft. Le of each trench Depth of trenches ft, I Size of Stone + She Pits: Number Size: 1 x Stone Size: LEM19ng Size Type Buildi to tank Tank to Distribution Box yt A 05 I Distribution Box Pit LA A k7v— .-Ji I Owninq Sea d* Partial I End Cap �F I Iniet/Outlet Pipes&Baffles I Y N Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft. 1 Conforms as per Plot Plan Y N En ineer Report and As-Built Y N Location of System on Property: Front ear Left Sld Ri ht d Middle Fro Middle Rear Uftm Use Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Last revised 021006 Last revised 1/6/05 D~ z~ ~. ___ r--_--- ~ m ~a o ~~ ..... ~~ ~ v ~~ ~~ t~ ~ `~ 6> ~~ ~~ ~~ ~ ~u~~ ..____v-- . ~ _ __. _ a~ ~~ Cj .~~,....,_.~, K ~~ ~ { ;~ rov~~z ~: _. ...;~;.~~,•~