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2002-624 .l ..f ff � 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: P20020624 Date Issued: Tuesday,December 02,2003 - . This is.to:certify that work requested to be done as shown by Permit Number P20020624 has been completed, Tax Map Number: 523400-301.008.0002.046-000-0000 Location: 18 PROSPECT Dr Owner: CHERYL A MURPHY Applicant: CHERYL A MURPHY This structure may be occupied as a: By Net of Town Board Septic Aheratfon Residential TOWN OF QUEENSBURY Director of Ming&Code Enforcement TOWN OF QUEENSBURY � Copy BUILDING 742 Bay Road,Queensbury,NY 12804-5902 (51$)761-$201 ' /Community Development-Building&Codes (518)761-8256FIL BUILDING PERMIT Permit Number: P20020624 Application Number: A20020624 Tax Map No: 523400-301-008-0002-046-000-0000 Permission is hereby granted to: CHERYL A MURPHY For property located at: 18 PROSPECT Dr 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: CHERYL A MURPHY Septic Alteration Residential 18 PROSPECT Dr QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications BP 2002-624 Construction of Septic System(residential) as per plot plan and specifications $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 23,2003 (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 Queens T esday,Jul. 23,2002 SIGNED BY AA or the Town of Queensbury. Director of Building&Code Eno eme Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8.256 3 Ja 1. OWNER INFORMATION: t ............................................_................................ ...................... QQ ' andV Location of installation: �7 (Q!.- � 1 e c j vim_,, Fife I�e�ic a L 2002 Tax Map No.3 G( 1 t7 _j_- -q 4, ' i Fee Paid, a nwNIa r),::s E-4,SSURY1 Owners Name: et'u x A . MU('p Address: Pro 5!:1 r:7e.Cw+�T�) r tv�. 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_flow) C7 Year of House: No. of Bedrooms x Computation - Total Daily Flow 1980 or older x 150 gal/bdr m = 1980-1991 x 130 gallbdrm = 1991 -present x __110 gal/bdrm Garbage Grinder Installed yes / no ✓ ��Spa or Whirlpool Installed yes / no s� 340 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) h ure Ground Wafer Bedrock or Impervious Material ter SuPRly sa at wh depth at what th municipal, Rolling loam I,, et feet Steep slope clay if well;water supply �%slope other from any septic-system depth: absorption is ft. other Percolation Test: (-b 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 I c Q �1�t�ST'A►�C� l_�e~i_i i. Septic Tank: gallon (nun._size 1,000 gal.) _ t -i--IFi Tile Field: each trench ft. Total System Length: 7-r* ZT� fl. ,LNr Seepage Pit(s): number of size ofeach: ft. by ft. Size of Stone to be used: # / depth or thickness 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 Towi•of Queensbury Sanitary Sewage Disposal Ordinance. Signature of, ponsible person Date Wil of (Itievals 111�1x�t�tlix (': . AJ;ISOM'!'I'IQN U111FAII_)" _ URFAM PO ND "w./_ y'!(�.1L IN 1�/iTF.'rZ- _..�.,.�r. Wrttp� !.s'ic••) ►emu s cs t1> , ��; ,t3='' 1 k•,xs� G E . 1 ' L _ ��1 -' - P S c r i t c, rr wMy - - 1+IY.xNtPtlLl r PI r+:✓p 7. SIGNATURE &INFORMATION FOR Rhb1'UNWLIU5 r>✓ .ri. ..�•�• •••••,•l i • Septic Inspection Report Office No. (518)761-8256 Date Inspe ion equest received: Queensbury Building&Code Enforcement .Arrive- 2 an-,/ Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: PERMIT NO.: 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: ft. Absorption Field: Total length Length of each trench ft. eb Depth of trenches ft. C Size of Stone See j)age Pits: Number d4b,"I /V'j- 00*4� Size: x AW L Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field Pit Opening Sealed: Y/NI Partial Location/Separations Foundation to tank Foundation to abso tion ft. Separation.of Pits ft. I Conforms as per Plot Plan Y_N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected,please call the'Building&Codes Office ,-Disapproved L:\SueHenungway\Building.Codes.Inspe.etion.FORMS\Septic Inspection Report doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection requ qu t ceive /0-3 Queensbury Bufilding&Code Enforcement Arrive: a p D 742 Bay Rd., Queen7sbury,NY 12804 Inspector's Initial P NAME: P T NO.: LOCATION: PECT ON: /-1, 1013 RECHECK: V 4� 14 z C21 Comments and/or dia ra Soil TypSZan oar Clay Type of Water: Municipal/Well Water Waterline separation distance Well separation distance ft. Other wells: ft. Absorption Field: Total length Length of each trench ft. Depth of trenches Size of Stone LSe�eage Pits: Number Size: - X Stone Size: Piping Size T e Building to tank 51, Tank to Distribution Box it Distribution Box to Field Pit 1-4 N3-Fl I Opening Sealeq LPartial Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft. Conforms as_per Plot Plan N Location of System on Property: Front Rear Left Side Right Side Middle - n�t Middle­Rear� System Use St tus: Approved Partial Approved and needs to be re-inspected,please call the'Building&Codes Office -Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection ReporLdoc January 28,2003 Memel C� p 11 4J 000 P� r� 4- 4- 4- 4 u 4Jleelee -C �.� 11 w w ' �J ' 00 � � ro rog Q r r"WL 0 r-a LL U w Z, V) ( 0 1 T' .0 }. et- p Q, :) w 0 E 0 0 u x a 4J 41 J VI u 21 . ,.� c� S. � a 4J x r-, H C N 4J CL W 0 , �hC Ci collreeo- O w-CU LLO 0� Cat L S. ro 0rwH U c 0 y ° rwg 0 04. av) � NQ � a4� w00C C -P00 4JP0 .-, S. 4J r . , 1IN Cr a 4- U� °' 41 �H rocn +� Ow NLLOrd � V t—,r � � � CCres c00 w Q r~ co x \ 000 OIXS. � k1 0 4- r 0 0 U) -r-r*r 0 N 0 A.U. 0 4- w to e° 4J O m 01 +� P ;r ,r � � id �1 t �.• �1 CIOCi. .0 00 I 0 4J cN m ro 0 � r 0 � r- �S a .0 W 0 L ° , °,r,�.°, '0 ro S. 0 U 4 r~w ,, I r7W+ w 0 0 c>� 0 J worn-P0a0C � rn� -PC � c �s .4 � UL / E U P Md N -0» CQNwN00 "0CN0U � � A. 0 'rQ �7 rtU 0 RI 0 Q?�r Cd 0 0 �r w-r ,N F� r r� �r` Q� 0 0 0 0 ULl9 � t qL "I have seen or observed, e ed,or believe I saw evidence of, � all objects such as houses,wells,trees,fences,etc,, shown on this document.I also represent that I have EXS�s�f personally measured the ' ances set forth on the diagram," /soap bra IGNATURE DATE Y'� TO VVN OP BUI n LDlN�Ada��CRY a � . N OF QUEEOU Qu� B ILDINC E IAA REVIEWED BY r DOTE i I L.1 lU �l