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2011-364 TOWN OF QUEENSBURY 742 Bay Road,,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 CE RTIFICATE OF COMPLIANCE Permit Number: P20110364 Date Issued: . Tuesday, August 23, 2011 This is to certify that work requested to be done as shown by Permit Number P20110364 has been completed. Tax Map Number: 523400-308-005-0001-002=000-0000 Location: .399 WEST MT. Rd Owner: GREGORY & LINDA FULLER Applicant: GREGORY& LINDA FULLER This structure maybe 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&Code Enforcement Planning'Board or Zoning Board of Appeals: TOWN OF QUEENSB_URY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518).761-8256 BUILDING PERMIT Permit Number: P20110364 Application Number: A20110364 Tax Map No: 523400-308-005-0001-002-000-0000 Permission is hereby granted to: GREGORY&LINDA FULLER For property located at: 399. 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 Qpeensbury Zoning Ordinance. Type of Construction Value Owner Address: GREGORY&LINDA FULLER Septic Alteration Residential 399 WEST MT. Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency BRADLEY'S SEPTIC SERVICE 654-6318 47 HACK Rd CORINTH NY 12822-0000 Plans&Specifications 2011-364 septic alteration residential $40.00. PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 28,2012 (If a'longer period is required,an application for an extension mustbe made to the code Enforcement Officer of the Town of Queensbury before the"expiration date.) Dated at the Town of QueensbuAy; Thursday,July 28,2011 SIGNED BY 0 r le for the Town of Queensbury .- - Director of Building&V de Enforcement __ ____OFFICE USE ONLY___."..:. , TAX MAP NO. PERMIT NO. PERMIT FEE D APPROVALS: ZONING TOWN CLERK JUL 2 6 2011 ?OWN OF-QUEEIVSBUR� APPLICATION-FOR SEPTIC DISPOSAL SYSTEM P ILDING& CODES A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: INSTALLER: ADDRESS:__ 3 ( 9 W � ADDRESS: "7 O PHONE NOS. PHONE Nos. S"I 3 i p LOCATION OF INSTALLATION: NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW 1980 or older X 150 gallon per bedroom = GARBAGE GRINDER INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992—present X 110 gallon per bedroom = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand_ Loam Clay OtherLL. ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? ✓ DOMESTIC WATER SUPLY: Municipal ✓wh Well. (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is minutes per inch [MPI] (Test to be completed by a licensed professional engineer or architect.) 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). TANK SIZE: GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage-grinder; spa or whirlpool tub. SYSTEM TYPE: ❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length' ft. Each•trench X ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ ALTERNATIVE SYSTEM_ �qe or other type? --ZJ \ ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN i APPROVED ELECTRICAL INSPECTION AGENCY.. PLEASE REVIEW LIST PROVIDED. 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 - QUESTIONS? CALL 761-8256 OR EMAIL Queensbury Sanitary Sewage Disposal Ordinance. codesCa�Queensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION www.aueensbury.net Signature of Person Responsible Date rr Town of Queensbury.- Community Development Office ■ 742 Bay Road, Queensbury, NY 12804 B 5-LGL 6/06 (3:00 ) Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart-7-i. am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: n "I1 )•�; NAME: Fuller PERMIT NO.: LOCATION: INSPECT ON: -- RECHECK: Comments and/or diagram Soil T Loam/Clay Type of Water• t Well Water Water a aration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A 150'to well required if NO Absorption Field: Total length ft. Length of each trench 42 ft. Depth of trenches ft. Size of Stone —4 win Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field Pit ('rz' Ftv Opening Sealed: _ N � L, End Cap N Inle Outlet Pipes&Baffles Y N Manholes 12"or less below grade N rovide adenslon collar if Yes N Location I Separations Foundation to tank ft. Foundation to absorption Separation of Pits it r4t— Conforms as per Plot Plan FN Engineer Report and As-Built _Y N ETU Maintenance Contract Y_N provided Location of Syste erty: Front Rear Left Side Right Side Middle Front Middle Rear stem Use S Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiling\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report-03 2910.doc i ` 1 hav seem or o sery d, or belie e I s w ev denc of, II obi�ds such as houses, veils, i rees, fences, etc , t� 0owi cn tl is do ume t. 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