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2001-305 � t TOWN OF QUEENSBURY AW742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010305 Date Issued: Friday, May 18, 2001 This is to certify that work requested to be done as shown by Permit Number P20010305 has been completed. Tax Map Number: 523400-301-012-0002-027-000-0000 Location: 368 DIXON Rd Owner: CONNIE CASEY Applicant: CONNIE CASEY This structure may be occuga'a a WRATH By Order of Town Board Septic Alteration Residential TOWN OFF QU/EEENSBURY Director of Building&Code Enforcement 11 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010305 Application Number: A20010305 Tax Map No: 523400-092-000-0001-001-022-0000 Permission is hereby granted to: PHIL WALWRATH CONNIE CASEY For property located at: 368 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: CONNIE CASEY Septic Alteration Residential 368 DIXON Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY,NY 12804 Plans &Specifications BP 2001-305 SEPTIC ALTERATION AS PER PLOT PLAN AND SPECIFICATIONS $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 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 To Queen, uryA; Thu day,May 17, 2001 SIGNED BY _ c ,/ 4(`/f'V k� for the Town of Queensbury. Director of Building o nforcement TOWN OF QUEENSBURY 4,0 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010305 Application Number: A20010305 Tax Map No: 523400-092-000-0001-001-022-0000 Permission is hereby granted to: PHIL WALWRATH CONNIE CASEY For property located at: 368 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: CONNIE CASEY Septic Alteration Residential 368 DIXON Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY. NY 12804 Plans &Specifications BP 2001-305 SEPTIC ALTERATION AS PER PLOT PLAN AND SPECIFICATIONS $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 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 ToagsCQueensba ry; Thursday,May 17,2001 SIGNED BY / 1� .� 'ti/ for the Town of Queensbury. f. Director of Building :oP ode t: forcemeat • • Application for Permit—Septic Disposal System •town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: - Location of installation: ��'3(5- h-i'Mit-' ,, d - Ofrice Use No. 9 •. File Permit Nog-3 Tax Map • Owner's Name: arl 17,-/C Fee Paid `�` . • . Address: a t-e- /),- ---3 kr (.vd REcElvED • - - . . 2. • INSTALLER'S NAME : 57 , ei J-.1l l' 1 C lgij1%1 A809 i`F.19• 1 3. RESIDENCE INFORMATION ►.it. , i .., :�.•-, , .•(circle year of dwelling, indicate #bedtTo`�m .�)�nd-�mu'lt:�ipl}j-fl.i��f . bedrooms with applicable gallons per bedroom- OtgaVoia rdai:�f 5w) . Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older 3 x .150 gaVbdnn = ~� 1980— 1991 x 130 gal/bdrm `� 1991 —present x 110 gallbdrm . . Garbage Grinder Installed . yes _ /i.no K Spa or Whirlpool Installed yes— / no -7 . 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) • op. t• . .t&c tl►° t!!t9 Q.round Water_ ocdrock.9r iviPerYivUs M.gerkal %_omit strc_..`.-itor_Supply Flat ra , at ► hhrr i emit . - n/Nhai le th . ' nrtrrriclp ling loam y� ' Meet Steep slope . clay l if well; water supply . ___%slope other from any septic-system depth: . . absorption is fl. • 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 amovcd subdivision). Add 250 gallons to the size • of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: /9 6O.gallon (min. size 4,000 gal.) • Tile Field: each trench ft. Total System Length: fl.. . • Seepage Pit(s): .number of. size of each: rfl. by Kfl. • Size of Stone to be used: ll 9 ' / depth or thickness_____:_-.___fret • 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 Quoonsbury, 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 those and all • requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. 5—i, --)6907 ' 3 ature of responsl leperson Date e —. \ . `.--53 -- 19:07() Septic Inspection Report Office No.(518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/prttv)$part: /i/„fir, '7_'_�am/pm 742 Bay Rd.,Qu`e-e�nssb�u'ry,NY 12804 Inspector'sl Initials:N ��LL((- PE LOCATION: �l� 2I�Cd INSPECT ON: --� 3 RECHECK: e Comments and/or diagram Soil Type: San' /Clay Type of Wa Municikal/Well Water Waterline sepa 'on ditance 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 -et__ Pits: Number Ali _ Q Size: x V _ Stone Size: t - Pipingi Sjge Type tx? SPZ/1I(f Building to tank Tank to Distribution Box J^ 604 "e5 Distribution Bo ield/Pit IA. 0 Opening Sealed Y NI Partial Location/Separations ( � Foundation to tank Foundation to absorption _ ft. Separation of Pits Z ft. Conforms as per Plot Plan N Location of System on Pro. • y: Front Rear eft Sid; Right Side Middle Front Middle Rear System Use St s: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L\SueHemingway\Building.Codcs.Inspection.FORMS\Septic Inspection Reportdoc January 28.2003 TOY( OF QUEENSBURY c2 31(D — BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY121104 (518) 161-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name ?/jii ti& `erne-//— (71 Locations '3(D7 (J'ic9�'— 11�y//—2� Date 7/ Ig/di Permit N /J1J SOIL TYPE: Sand-Loam-Clay- Results of Perco ati . Test- (if applicable) 'ate inute/Inch TYPE OF SYSTEM: ABSORPTION FIE 1: Tot.1 Length Length of each .rench Depth of trenche- Size of stone SEEPAGEPITS: / Si - fze � B ft. Stone size PIPING: 3 rSiz Type Bldg. to Tank C s ^- Tank to Dist. Box H'' Dist. Box to Fiel ./Pit L[ Openings Sealed? Yes No 'artia LDCATION/SEPARATIt S: S feet Foundation to Tan Foundation to Abs.rption feet feet Separation of Pit Conforms as per P1 .t Plan Yes No LOCATION OF SYSTE ON PROPERTY: (circle one) Front - Rear - 411 - Right Side Middle Front - Mi . . - 'ear COMMENTS: ej, /( 4- SI4 �F /Q4 sir>) L/ 900 2 SYSTEM.USE APPROVED: YE NO Arrived: Zr3' Departed: Building Inspector TO* OF QUEENSBURY /4 34 BUILDING A CODE ENFORCEMENT 742 Bay Road Queensbury NY_12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Gt-1- Location 3 %) Date _____J/ Permit # 2e0/_of SOIL TYPE: Sand-Loam-Clay- Results of Percola 'on Test- (if applicable) R. - Minute/Inch__ TYPE OF SYSTEM: ABSORPTION FIELD: I . :1 Length Length of each tre Depth of trenches Size of stone V SEEPAGE PITS: umb?r- Size - ft. - f----t Stone size PIPING: Size ype Bldg. to Tank Tank to Dist. Box Dist. Box to Field/P't Openings Sealed? es Ep art:a LOCATION/SEPARATIONS Foundation to Tank Foundation to Absorp — feet Separation of Pit ion feet Conforms as per Plo - Plan _ feet No LOCATION OF SYSTEM I. . PROPERTY: s (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: Gde,./ Geer A6Li ait Stt SYSTEM USE APPROVED: YES Cep/ Arrived: till Departed: Buf]ding Inspector TOW OF QUEENSBURY ,rye _ , BUILDING & CODE ENFORCEMENT ,1l(JY���/�jj,j,���, 742 Bay Road ,�\ Queensbury NY 12804 {l�la� (518)761-8256 4y(4 SEPTIC DISPOSAL SYSTEEMaIINSPECTION \ Name ° T\ � WO)Ne"0 \h Location 314A CD) $m \ Date L —3C ap)Pennit # SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Yes No artia LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: La e 4...,1 Ar Aka, 12 - r CO) IrY /0.4r SYSTEM.USE APPROVED: YES NO Arrived: Departed: Building Inspector insPeCW Building - e- —_ - '�ie,zendre Meets-rrchas ho me:ye s frees, fences,etc., -- - -- - - _---- �` Y Preseutthatrhave S @J>' +rnLn this document.f-also-re - ersanall measured the distances setfortheo-thediaram"- — -- SIGNATURE - LATE _ exI1I f _ „do 5 tcc, 4.1 * ,4 , ti - � Qr'v�E ``FBURY gxla BUILDPto1G & d EPT. --- -- - _. REVIEWED BY ---- --� _. .. DATP _. -.. cc C!" • .l c - V � r Urt