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2004-967 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 CE RT I F I CAT E OF COMPLIANCE Pemit Number. P20040967 Date Issued: Monday, December 11, 2006 This is to certify that work requested to be done as shown by Permit Number P20040967 has been completed. Tax Map Number. 523400-301-013-0001-004-001-0000 Location: 573 WEST MT. Rd Owner. MICHAEL & SHAREEFAH DRAHOS Applicant: MELANIE SCHWAB 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&Co Enfo ement Planning Board or Zoning Board of Appeals. Application for Permit®Septic Disposes System Town of Queensbury 742 Bay Road Queensbury,M' 12804 (518) 761-8256 1. OWNER WORMATION: ............................................................................................................. Location of installation: 7 e®1 11 �I � Office Use J 194 _ File Permit No.oq-- Tax Map No. ,W j r as Owner's Name: Fee Paid � .`f1� _ �x�` ..... ...............................-.,,...,,..,.,,,.-..,,,,......,,.................................,.............. Address: 2. INSTALLER'S NAME o,� G�MQ �c, PHONE NO. 6I;,�3l� 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroo3 s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) -Year of&use: No Bedr orn - -3:otal DLIy Flow 1980 or older' x 150 gal/bdrm = 1980—1991 x 130 gal/bdrm - 1991-present x 110 gallbdrm = Garbage Grinder Installed yes,+ / no �~ l Spa or Hot Tub Installed yes- 1 no 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) I-moxaphy 7 Sol Nat me. Ground a hedr-ock-or LmPervious Material D-omestig Water S 1 Flat sand at what depth at what depth municipal Rolling loam feet feet well Steep slope clay if well-,water supply 4 slope other from any septic-system depth: absorption is p ._..,q,ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch S. PROPOSED SYSTEM: For Dtew 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: f-15 a gallon(min.size 1,000 gal) Tile Field: each trench fl, Total System Length: Seepage Pit(s): number of _ size of each: ft. by Size/Qf Stone to be used: # / depth or thickness felt ° Bed system size: `I x ��' r0jV OF�C 2004 Alternative System: length attd/or size e�ll0�G�UFAA F�IS 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. Signature of responsible person Date I • �........,.��.,��tr,����rsxc�t���� t•�4a�.A�x. o�ru� �xtzt,�ra��s '� w w 1• . r mow~ y' %wo•,M ..may. rr.y�' • . 0 *"DI 1,1 JS y www 4�fww�r, �� ,r+ 1 ' aMu�Yl a+�' � M !` •Zl.Y1V�i tit 't't',�t.� , .•�� a, V QNO,d 4 s� I Email- t n b5ilI N0. 1,I,VII V41,51a' r r . , y •I 1 . �.lalclattt'�ci�'•�n �'1A1p,I.� . d • ,td4 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040967 Application Number: A20040967 Tax Map No: 523400-301-013-0001-004-001-0000 Permission is hereby granted to: WT,ANTF, SCHWAB For property located at: 573 WEST MT. 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: MELANIE SCHWAB 175 BROAD St Suite 301 Septic Alteration Residential Total Value GLENS FALLS,NY 12801 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-967' SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,December 20, 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 Queen /Ztda December 20, 2004 SIGNED BY for the Town of Queensbury. �.' Director of Building&Code Enforcement Septic Inspection Report Office No. (518)761-8256 Date Inspection r ue t recei e Queensbury Building&Code Enforcement Arrive: am/ m Depart: 742 Bay Rd., Queensbury NY 12804 Inspector' Initial - i NAME: - A P IT NO.. LOCATION:s SPECT ON: L 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 Q,11 h 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 f. Conforms as per Plot Plan Y N 6t5v kc i p\' Location of System on Property: - ���Z Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Zi provedrtial Approved and needs to be�e-inspected,please call theBuilding&Codes Office sapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report ` --� Office N - /�e o. (518}761 8256 Date Inspection req��r ei ed: Queensbury Building&Code Enforcement Arrive: m epart: .1 _ 742 Bay Rd., Queensbury,NY 12804 Ins ,ctoT's fiiitia NAME: U� P RMIT NO.: LOCATION. - ASPECT ON: — RECHECK: Comments and/or diagram Soil Type: an - 3rI -C T e of r� Munici a Well Water---- Waterline se aration distance ft. Well separation distance ft. 7+�iN+'GiJ� Other wells: ft. Absorption Field: Total lengt1i Length of each trench ft. �`��� �� x 6 z'\ Depth of trenches Size of Stone _ .-Seepage Pits: Number Size: x �� \A,p1 Stone Size: l 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 Foundation to absorption ft. _LTT \z_t1_\� zl v__ Separation of Pits Conforms as per Plot Plan Y Location of System on Property: Fro t ea eft Side ght Side Middle Front Middle Rear System Use Status: proved artial 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 r ue rec Queensbury Building&Code Enforcement Arrive: am/ m 1�part: amlp'm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initi s. NAME: Ou;A P IT NO.: LOCATION: yT�M Uti �_ m' RD SPECT ON: 17--?--7-n!4 RECHECK: Comments and/or diagram Soil T . Sand oam/Clay _.Type o icI ell Water Waterline se ara on Istance ft. Well separatrorr4istance ft. Oth wells: ft. c� � icy 3 Abso tion ie d: Total lengtht� ft. (��3�L�iU 4v Len h of each trench .ft. Depth of trenches ft. y., u u- Size of Stone Seep a e Pits: NumberSiz x ��, �- \ �•� `tU� c�.\is t Stone Size: Piping Size Type Building to tank L-Q Tank to Distribution Box Lx Distribution Box to Field/Pit qL Opening Sealed: Y/ as Location/Separations Foundation to tank ft. Foundation to absorption 1-41 � _.. Separation of Pits ft. Conforms as per Plot Plan Y Location of System on Property: � � Front Rear Left Side Right Side Middle Front Middle Rear System UsVStatus proved ial Approved and needs to be re-inspected,please call theBuilding&Codes Office approved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Rep ort.doc January 28,2003 4 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: -)rakoL PERMIT NO.: 2CC41 �/ l7 LOCATION: Rit 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 NJ Partial End Ca Inlet/Outlet Pipes &Baffles Y—N 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 S s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 apt . r* ap of 1 ds surveyed for Q occ o <: Al a mp S Marto .y Town of Queensbu * Warren County * New York L.820- P. 315 Scale: 1" = 30' December 27 2000 �� �� � � �=O SIGNORELLI LANDS O"F St>� ey and Map by W y e R. Raymond l_ 1 304.92' -" /.P.F. Lice s d Land Surveyor E I V E D S_ 70=43-25' E Glens F I s & Wevertown, N.Y. � J9N 0 8 2001 f LPF l I,WN OF QUEENS13URY BUILDING AND CODE p F out DEPT• `o BUILDING & COD ` K .. DEED REFERENCE. REVIEWED By KARA M. DOPMAN To TRU:STCO BANK, NATIONAL ASSOC/AT/ON pi O �s o L.I126- P. 26/ -22-99 e +� i ja 44 2Q5 ' AREA = 2.61 AC. Qt o W Q140 o z o Q 16.0 I.RF ENOTES IRON PIPE FOUND. 102.76 00!E w 1 2✓5_79-• 5- o � 4 � a grave/ drive a 3 , � Mb I32.3' — Q o� 3 t TAX MAP PARCEL .' /23— l— 9 `' � fI.P.F. N-67140=40=' W 452.3941 LANDS OF LEUCI L.B7B_ P.� I47 : w. ltlC '10 03UOPIn9 uses I GAGIIa �;, 'ua�;lr°pro O 41 M.