Loading...
2004-815 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: P20040815 Date Issued: Tuesday, October 19, 2004 This is to certify that work requested-to be done as shown by Permit Number P20040815 has been completed. Tax Map Number: 523400-301-012-0002-032-000-0000 Location: 382 DIXON Rd Owner: BRYAN LA LONE Applicant: BRYAN LA LONE 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, / Variance, or other issues and conditions as a result of approvals by the Director of Building ACde Mforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-45902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040815 Application Number. A20040815 Tax Map No: 523400-301-012-0002-032-000-0000 Permission is hereby granted to: BRYAN T,A LONF. For property located at: 382 DIXON 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: BRYAN LA LONE Septic Alteration Residential 382 DIXON Rd Total value QUEENSBURY,NY 12804-0000 Contractor or Builders Name/Address Electrical Inspection Agency Plans &Specifications 2004-815 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 19,2005 (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 To( of Bens October 19,2004 SIGNED BYF d for the Town of Queensbury. 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 Use Location of installation: File Permit No. Tax Map No. / ! � nG Fee Paid Owner's Name: ..........................................................:.......................................................................... Address: Xo� !�• h v�^ INSTALLER'S NAME 540��e �-N Il 4 bf'S PHONE NO. S�� — 6 LIP, -- Z 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#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 = 3©O 1980—1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no Spa or Hot Tub Installed yes_ / no 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) To a h So' e Ground Water Bedrock or Impervious Material . Domestic Water Su 1 lat s at what depth at what depth municipal olling loam --�— ee west-- well nd Steep slope clay if well; water supply _%slope other from,any septic-system depth: absorption is ft. other Percolation Te t: (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. � n � tu Septic Tank: DoD' gallon(min. size 1,000 gal.) �`� ��FRI� Tile Field: each trench__f! !1 ft. Total System Length: ft. O C T 1 5 2004 Seepage Pits : number o size o each: t. b t. TOWN OF QUEE1,1SBUPY ( ) f f f Y .f BUILDING AND COi?F Size%f Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length and/or 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 e own of Queens Sanitary Sewage Disposal Ordinance. Si -nature 91 r onsible person Date :,I�owll of (111CN11s1 ui-Y Ss�tvt:I:y :ultl 'Scwsil)D Disposal tlhupl(•t• Appi- tlix C. _ • � Aj.�.�t)Ii.�'•''�'I()�I, Ii'II.I�I.) , 9I:I'/11tA'I'1W1N It1:�Z1.I11ti 11]ItIN'1':l 1 ' POND ' 't111�11! CJ�S'I�IC; , yr+'�►.., rt tc is�� . IV Ga .r + • A��tJRPt1G1 1 F�111.Lb � r ' • ter• •�"'•+w�~ Rahn 7. Si TNA►TLMB &INFORIviA7j0j1'F0F,MS1JVNb=Lr,rZr%4vLY u„o,A..,•.r...:, Septic Inspection Report Office No. (518) 761-8256 Date Inspection re est�c ive Queensbury Building&Code Enforcement Arrive: m/p part: ! a �/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia • {- NAME: h o,J� P IT NO.: C LOCATION: t ECT ON: RECHECK: Comments and/or diagram Soil Typ San oam/Cl Type of Wat : M nieipal/ atel Waterline skparatiLoDi ce ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench L*-, Zft. Depth of trenches °- / ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank ►.��` j tIC,�=t 1�`j Tank to Distribution Box Distribution Box to Field/Pit �' •� — t ���������i 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 VN Location of System on Property: `C Al! . Front Rear Left Side Right Side ��VV Middle Front Middle Rear System Use Sta s: Approved L 'ti% \ `� \ C-C) Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved 1 L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 l Y Septic Inspection Report Office No. (518)761-8256 Date Inspection requesl received: Queensbury Building&Code Enforcement Arrive: am/pi pa -Z am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials. NAME: Vw"x(LY-1 LC, �.,�- .gyp PERMIT NO.: LOCATION: INSPECT ON: RECHECK: � � _ Comments and/or dia r m 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 �]�� S lJ l�— �G "¢'Xj Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as_per Plot Plan Location of Sys on Property: Front Rear Left Side Right Side Middle Front iddle Rear System Use Statu . Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Htiilding.Codes.Inspection.FORMS1Septic Inspection Report.doc January 28,2003 I I I I I I I I I I I I i t i � l l l l IT I I I I I I i ; ! II IIII I i I I i i I I I i ��j It !f7, i I I �C�r) III _�__� I � f ► l i _T IIIII IV1 I i I Q �I I j - I