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2004-485 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. P20040485 Date Issued: Monday, December 11, 2006 This is to certify that work requested to be done as shown by Permit Number P20040485 has been completed. Tax Map Number. 523400-296-007-0001-018-000-0000 Location: 107 COUNTRY CLUB Rd Owner. JAMES & CHRISTINE MARSHALL TRUSTEES Applicant: JAMES & CHRISTINE MARSHALL TRUSTEES This structure maybe 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, 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: P20040485 Application Number: A20040485 Tax Map No: 523400-296-007-0001-018-000-0000 Permission is hereby granted to: JAMBS & C',HRTSTU%TF MARSHAT,T,TRTTSTF,F,S For property located at: 107 COUNTRY CLUB 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. Type of Construction Value Owner Address: JAMES & CHRISTINE MARSHALL 107 COUNTRY CLUB Rd Septic Alteration Residential Total Value QUEENSBURY,NY 12804 Contractor or Builders Name /Address Electrical Inspection Agency T.B.S. SEPTIC 2 LOWER WARREN STREET OTJEENSBTTRY_ NY is Plans&Specifications 2004-485 SEPTIC ALTERATION $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday, June 28, 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 Town of Queensbury; Monday, June 28, 2004 SIGNED BY for the Town of Queensbury. Director of Building diaiforcement Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am Depart: am/pm 742 Bay Rd., Queensbury, NY (12804 Inspector's Initials: ,�- NAME: �aY^S`'lC��►'( ) PERMIT NO.: 2�z/ �,S— LOCATION: �C7 ��7l�on �.1 JY� RJ 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 Fieldl Pit Opening Sealed: Y N Partial End Ca Inlet/Outlet Pipes&Baffles Y N Location/ Se rations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use us: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 L OWNER INFORMATION: Office Use Location of installation: 4f ® CQ 1j,A, (` w fj l� File Permit No. •'. Tax Map No. j � I Fee Paid Owner's Name: .^'4C S� (1` �0 Address: C��y� r Cv� 3 � s a 2. INSTALLER'S NAME r ✓ � PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 4 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 = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes, / no Spa or Whirlpool Installed yes_ / noKit 4. PARCEL INFORMATION: (circle applicable information&indicate measureme&fl 2004 Togi�araDhv SoiWature Ground Water Bedrock or Impervious Ater Supply Flat sand at ha depth at w t depth ing feet feet well 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: 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. ,�,� C- kI S/, - Septic Tank: 1 gallon (min. size P,00.0 gal) Tile Field: each trench ft. Total System Length: ® ft Seepage Pit(s): number of' size of each: ft. by ft. Size of Stone to be used: #_ l depth or thickness U(A feet Bed System Size: x Alternative System: length andlor 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 of the Town of Queensbury Sanitary Sewage Disposal Ordinance. l> / P` �d Signature of resp n 1e p on Date �df L `N� Ak Olt .�.. IV 0 pM Cc "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 a?so repres-I nt th t ! have " h on the diagram." personal{1 ~e � i SIGNATURE DATE 13UILDI id REVIEWED CDATE ,.,,�•• � brd , 330 9 Septic Inspection Report 1> p p Office No.(518)761-8256 Date Inspection red est r c 1v d: Queensbury Building&Code Enforcement Arrive: am/p epar m/ 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi Is: NAME: �CAmQ � _ PE IT NO.: o 4-q&S LOCATION: ECT ON: RECHECK: Comments a=1�diaram 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 End Caps Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Statu Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved Last revised 116105 Septic Inspection Report f Office No. (518)761-8256 Date InspectiIreest r cc' cd)Queensbury Building&Code Enforcement Arrive: /p �e art: S�'+ am/pm742 Bay Rd., Queensbuly,NY l2804 Inspector's In (`(`NAME: (1� Y IT NO.: ��7-4 S LOCATION: /Q v� �oECT ON: RECHECK: Comments and/or diagram Soil Tyg. Sand IkAdm/Clay Type o W unicipal/Well Water Waterline separation distance ft. Well separation distance ft. Other,wells: ft, Absorption Field: Total length Length of each trench Depth of trenches Size of Stone Seepage Pits: Number Size: x Stone Size: pipina Size Type Building to tank Tank to Distribution Box i Ian Distribution Box to-13ielp Pit Opening Sealed: Y/ /Partial Location/Separations i Foundation to tank Foundation to absorption ft. Separation of Pits ft Conforms as per Plot Plan Y VN Location of System on Property: ���� Front Rear Left Sidee Right Side Middle Front Middle Rear System Use Statu Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved 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/pm Depart: am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: L NAME: 1 PERMIT NO.: Q O0 - LOCATION: -- � INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance Well separation distance ft. Other wells: $. Absorption Field: Total length ft. Length of each trench ft.Depth of trenches $. 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 End Caps Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _Y N Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: a / Approved �—Partial Approved and needs to be re-inspected,please call the Building& Codes Office Disapproved Last revised 1/6/05