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2002-038 TOWN OF QVEENSBURY 742 Bay Road Queensbury NY 12804-5902 (518)761.8201 Community Development-Building&Codes (518)761.8256' i IFI%'.,A'TE V'r rCOMPLIAN�.L Penn t Number. P20020638 Date Issued: Monday,December 11,2006 This is to certify that work requested to be done as shown by Permit Number P20020038 has been completed. Tax Map Number. 523400-289-017-0001-034-000-0000 Location: 95 BIRDSALL Rd Owner: RAYMOND&BEVERLY LOCKHART Applicant: RAYMOND&BEVERLY LOCKHART 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 owner of the responsibility for compliance with Site Plan property P tY p 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 All . 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518)761-8256 BUILDING PERMIT Permit Number.- P20020038 Application Number: A20020038 Tax Map No: 523400-289-017-0001-034-000-0000 Permission is hereby granted to: RAYMOND&BEVERLY LOCKHART For property located at: BIRDSALL 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. Tne of Construction Value Owner Address: RAYMOND&BEVERLY LOCKHA septic Alteration Residential 57 SWEET Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency I.B.S. SEPTIC,_ 2 LOWER WARREN STREET QUEENSBURY,NY Plans &Specifications 2002-038 SEPTIC ALTERATION AS PER APPLICATION $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,January 17,2003 (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, �eensb 'T ursdpy,January 17,2002 SIGNED BY AeA— for the Town of Queensbury. Director of Building&VeE� rcement Application for Permit—Septic Disposal System Town of Queensbury742 Bay Road Queensbury,NY 12804 (518) 761-823RECEIVED 1. OWNER INFORMATION: ................................... ...........JAU I r.....ZQU...................... Location of installation: Z�S- Office Use TOWN OF QUE-ENSBURY File Permit ii ntNk',AND GO)D-fL Tax Map No. AM Owner's Name: Fee Paid .......... .................. ............... ......... .. ........... Address: t. t/(' 2. - 'INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATION:' (circle year of dwelling, indicate,#bedroom(s) and multiply of bedrooms with applicable gallons per bedroom to equal total daily v,64� � Year of House: No. of Bedrooms x Computation = Total Daily Flow Q 1980 or older x 150 gaVbdnn = 1980- 1991 x 130 gaYbdrm = 1991 -present_ x 110gal/bdrni = Garbage Grinder Installed yes no Spa or Whirlpool Installed yes no 4. PARCEL INFORMATION:. (circle applicable information &indicate measurements) SOMNature C irand Water Bedrock or Impervious Material Domestic Water Supply Fla (,and_) at what depth at what dq,th =Iil7al Rolling -toam— Oil' Steep slope _ clay Oil water supply %slope other from any sept* I m depth: absorption is 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 Icach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: /Q0 gallon (min. size 1,000 gal.) Tile Field: each trench ft Total System Length Seepage Pit(s): number of size ofeach:. ft. by Size of Stone to be used: # depth or thickness feet Bad System Size: X Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each:/A do gallons /TOTAL Capacity:Dgp gallons Note: Alarm System and associated electrical work must be inspected by A Town approved electrical inspection agency. T. 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 . INSPECTOR"S REPORT Dept. of Community Development Building & Code Enforcement Town of Queensbury (518) 761-8256 742 Bay Road Queensbury, New York 12804 Date: Property Location: e7)— Owner/Tenant: BUILDING SEWAGE SIGN OTHER REMARKS: Tax Map No. egtlk 4?49&1- 191 ro" ' 1-01, CONTACT THIS OFFICE WITHIN Building Inspectov r Septic Inspection Report Office No. (518)761-8256 Date.In7s1nitials: nrequest received: Queensbury Building&Code Enforcement Arrive: am/p�m �1Depart; am/pm 742 Bay Rd.,Queensbury, NY 12804 Inspect --U-L NAME; tom..,i- PERMIT NO.: 2 cad? LOCATION: `71sk INSPECT ON: RECHECK: Comments and/or diagram Soil T : Sand Loam/Clay T of Water: Munici al/Well Water Waterline separation distance • Well separation distance ft. Other wells: ft. Absorption Field: Total lencith ft. Length of-each trench ft. Depth of trenches ft. - Size of Stone Seepage Pits: Number Size: x Stone Size: f Pi in Size I Type Building to tank Tank to Distribution Box Distribution Box to Field Pit 0 nin Sealed: Y N Partial End Ce Inlet/Outlet Pipes&Baffles Y N Location/Separations Foundation to tank ft. Foundation to absorption ft• Se ration of Pits ft• S� c `�L ` "� Conforms as per Plot Plan _Y N En lneer Report and As-Built Y_N A Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear %vstem Use Status` Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised I/6/05 3, Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: -9., o- am/13M E' part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials. .0 ' ' NAME: PERMIT NO.: LOCATION: t Q- 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: ft. Absorption Field: Total lenqth ft. Length of each trench • (rc", ?�Depth of trenches U71 � ,'! k-- Size of Stone l 3'ZI , 7(ybo Seepage Pits: Number . Size: x Stone Size: C i o, ezc� 7Z7va^-& Piping Size Building to tank 36 0� 'S- . Tank to Distribution Box Distribution Box to Field Pit Openinq Sealed:. Y I NJ Partial End Cap__ Pipes&Baffles T-- Location j.,SepArattons._,_ Foundation to tank Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and.AsIll Location of System on Property: Front R Left Side Right Side Middle Front Middle Rear System Use tus'Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 � I R PEWEIDI BY e 20G2 ATE : L TO1Mi1J pF �ENSSuFIY SUJlD1Np .! • ND CODE LE�t tv f• 40 • �• fit: .�S \ -• � E'• S :otx • - `s ' ••'•' "vt.�t• .• •''I'i`Y'"r^rr�•t.•. .`�'. .i:y •"''`. 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