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97-504 • CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date 19 iS63 , 3 • This is to certify that work requested to be done as shown by Permit No. 97504 has been completed. • This structure may be used as a SEPTIC ALTERATION Location 330 DIX AVE. Owner LIVINGSTON FURNITURE By Order of Town Board TAX HAP NO. 110. -1-21 TOWN OF QUEE U Y (--- Director of Building & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. VALUE $ 0 97504 TAX MAP NO. 110. —1-21 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to LIVINGSTON FU'RSTYTURE OWNER of property located at 330 DIX AVE. Street, Road or Ave. in the Town of Queensbury,To Construct or place a S E P t; i '' at the above location in accordance to application together wt plotI t#-a#d�dither information hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1. OWNERS Address is. 330 DIX AVENUE QUEENSBURY, NY 12804 2. CONTRACTOR or BUILDER'S Name I. B. S . SEPTIC 3. CONTRACTOR or BUILDERS Address 2 LOWER WARREN STREET QUEENSBURY, NY 12804 4. ARCHITECTS Name 5. ARCHITECTS Address 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( 1 Masonry ( 1 SteeY E P TI C 7. PLANS and Specifications SEPTI ' ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8. Proposed Use SEPTIC ALTERATION $ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES SeratPmhPr 19 99 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) Dated at the Town of Queensbury this 2 Day of September 19_ 9 7 SIGNED BY OWeJ4e;1;;;\ for the Town of Queensbury Building and Zoning Inspector y • Application for Jt,Y 1 IL )IJYVJAL Yt'K '1I.1. Town of Queensbury Permit Nog, / -co Dept. of Community Development Building &Codes Office d 742 Bay Road Fee Paid $ Queensbury, NY 12804 Location of property for installation:Ci tr),t) %a ik 4 n r c CD t.,A c r .Q rr u- /J' r u c-c Property Owner's Name: CA.,`n) S%.. S ,..,,�� r Property Owner's Mailing Address: /), /Q(-LCQ 6 J Installer's Name: r ��. �i�i�. Phone # ' )21" - Y-1,1( Number of bedrooms (if residential): Total dni1v flow: /D 0 , /,, (residential - compute @ 130 gal./bdrm.) Topography: rolling, steep slope 9a of slope Soil Nature: sand, loam, clay, othc/depth: Ground water: at what depth:VIA feet / Bedrock or Imperr_cus Material: at what depth? _ feet Percolation test: l�/ not required, required [rate min. per inch ] Domestic water supply: X municipal, well, If domestic water supply is a WELL, water supply from any senc absorption PROPOSED SYSTEM <<• r - • • 02 lan Septic tank/00 gallon (minimum size: 1,000 gal) Tile field: each trench $c) feet / Total system'igth: alb Seepage pit(s): number of / size each: ft. by ft. Size of stone to be used: # / depth or thickness i feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each. gallons , • Alarm system and associated electrical work to be inspected by:certified agency. For your protection, please note that pursuant to Section 136-29 of the Code of Town of Queensbury, any permit or approval granted which is based upon or is granted in reliance upon any matemd misrepresentation or failure to make a material fact or circumstance}mown by or on behalf of an applicant, shall be _ I have read the regulations with respect to this appli - and agree to abide by ese and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. —) Sigiature of responsible person: C C. Date: v -2 > 716o SIC It�r4r3-er TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 0), v i n �)\--Y111'lyYe__, Location 3 W 0I c U� Date-I )-5 Permit # C\-1"504 SOIL TYP .df" •: C1 ay- Results of Pe col .tion Test- (if ap'pl i cabl e'.) 'Ra Le-Minute/Inch 1 TYPE OF YST: :, Zip ABSORPTI I LD: Total Length •r ►i-r•10 Length of eac' -nch ti Depth of trenc es .. Size of stone SEEPAGE PITS: mber- Size - I •- ft. Stone size - PIPING: Size Type Bldg. to Tank ' .NLti-,'V-tta Tank to Djst. Box _ Dist. Box to Field/Pit �it F�ss� Openings Sealed. Yes No Partial LOCATION/SEPARATI . Foundation to Tank ' E.j.c feet Foundation to Absorption _(Q feet Separation of Pits feet Conforms as per Plot Plan —< No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front Rear - Left Sid - Right Sid Middle Front - Middle Rear COMMENTS: SYSTEM USE APPROVED: Y NO Arrived: _R(� Depart• I - 441110 Bui: ding I rector gl2a_j1LX GENERAL INSP CTION REPORT Town of Queensbury Dept.of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road !! Queensbury,NY 12804 Arrive am/pm Departl' 'itat pm spector's Initials J NAME: 'S\ ,, CSPERMITa21:SO_ LOCATION:TYPE O TRUCTURE: : �` 0' Fec RECHECK N/A YES NO OMMENTS Footings/Piers Monolithic Pour Form Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placement of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Fount. i on/Dampproofing loll Approval Plumbing Under Slab Plumbing Vent/Vents in Place Rough Plumbing Heating Rough-In Insulation Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- Proper Vent, Attic Vent Framing Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3, 4 hour Firestopping _ / GENERAL INSPECTION REPORT Town of Queensbury Dept.of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road 1 Queensbury,NY 12804 Arrive am/pm Depart _(0 am/pm Inspector's Initials e-------1 NAME: 4C ' (0P4P. PERMIT# '5 LOCATION/6-37 lk )- d D 3 DATE : fltf3 TYPE OF STRUCTURE: RECHECK Lers N/A YES NO COS / I Monolithic Pour Form 1.---)- ,� Reinforcement in Place The contractor is responsible fo r ros-r) providing protection from freezing for 48 hours following the placement of the concrete. Materials for this p se on site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofing Backfill Approval - A)0 9— R )ei---b6'r Plumbing Under Slab Plumbing Vent/V is in Place Rough Plumbi g Heating Rough-In qr. - 4-G�� w(3i .K Insulation ,u Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- ` � Walls R- R6'1`0 VC Ca 0 1 [__ Ceiling R- �� Duct work or piping in CO,)2 (/ unheated spaces R- Proper Vent, Attic Vent Framing Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3, 4 hour Firestopping GENERAL INSPECTION REPORT Town of Queensbury r ept. of Commu;'ity Development Date inspection request received: Building Code Enforcement 742 Bay Road / I`?,, Queensbury,NY 12804 Arrive am/pm Depart/4 t a pm / Inspector's Initials 2> NAME: U PERMIT# —�J o ✓ LOCATION: ��r2 24 F‘&M DATE : `'/ /a g7' TYPE OF STRU TURE: RECHECK ,1 N/A YE7NO COMMENTS Footings/Piers Monolithic Pour Form Reinforcement in Place ' L — The contractor is responsible for providing protection from freezing for 48 hours following the placement of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcemeaitin Place Foundation/Dam Backfill Approval Plumbing Under Slab Plumbing Vent/Vents ' Place Rough Plumbing Heating Rough-In, Insulation Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- Proper Vent, Attic Vent Framing Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3, 4 hour Firestopping "I have seen or observed.or believe I sew evidence all object such ea house,,wed,his,faxes.eit, shown on this document.I also reposed that I hove personally the distances set forth on the am." >) ? • SIGNkU DATE PLOT PLAN SEPTIC SYSTEM . Notice: The following statement must be "stamped" on your plot plan. This sheet of paper may be used for purposes of drawing your plot plan. After drawing such plot plan, please read the statement and sign it. If you choose to use other paper for your plot plan, the office will stamp those plans for your signature. (A. r 1 K — n' - ■ o 'V ,. r.�G ,`mac. , 1?"c"',e •r r,, , ,,,. l�,,, r _ ,it.. ` , 'z, ,; , 1327 zv f r.-'.: F: d f. R VIEWED BY .s ® TE (- k \ r,,z,,J.,,,A7 poi , _ , ,, 0( f r -(,-._ eCyr 'n il 1 - j i 1v r J �J/:—_(‘ A 9 (A C./ (, _p a i J , 1 K� l 4 r V