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2011-553 411" TOWN OF QUEENSBURY IF4TO742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building& Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110553 Date Issued: Thursday, November 17, 2011 This is to certify that work requested to be done as shown by Permit Number P20110553 has been completed. Tax Map Number: 523400-295-006-0001-007-000-0000 Location: 9 OLD WEST MT. Rd Owner: PETER &NANCY BRILLING III Applicant: PETER &NANCY BRILLING III 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 /� pd property owner of the responsibility for compliance with Site Plan, �'c" 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 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 F4TO Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20110553 Application Number: A20110553 Tax Map No: 523400-295-006-0001-007-000-0000 Permission is hereby granted to: PETER &NANCY BRILLING III For property located at: 9 OLD 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 Queensbury Zoning Ordinance. Type of Construction Value Owner Address: PETER &NANCY BRILLING III 445 MONROE Ave Septic Alteration Residential CAPE CANAVERAL,FL 32920-000 Total varve Contractor or Builder's Name/Address Electrical Inspection Agency MORNING STAR SEPTIC 793-2290 744-8139 107 JEWELL Rd GANSEVOORT NY 12831-0000 Plans&Specifications 2011-553 septic alteration residential $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,November 04,2012 (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 Queens ry; iv; ► ivember 04,2011 �' for the Town of Queensbury. SIGNED BY � Q ury Director of Building&Code Enforcement Revised 4/14/2010 OFFICE USE ONLY LY� TAX MAP NO.2 /,.J ,6--/'PERMIT NO. f/513PERMIT FEE II U---„ • APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: 41•74•••A J#A.R/, INSTALLER: / ``� 7----/ ADDRESS: 9 CD Ute4/41, ADDRESS: /C ) )..11..„,...‘a-f— •dc r { PHONE NOS. PHONE NOS. 7 9'3-2-'500 — .) y 9 F/Y 6r LOCATION OF INSTALLATION: RESIDENCE INFORMATION: NO.OF X COMPUTATION YEAR BUILT = TOTAL DAILY FLOW • BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older 3 x., X 150 = 1715-v INSTALLED? 1981-1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND )C LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpg (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(kilN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for .2424,4_ each garbage grinder,spa or whirlpool tub. / SYSTEM TYPE: O ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? L/X(0 ❑ALTERNATIVE SYSTEM Bed or other type? ❑HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN 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 Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Sewage Disposal OrOipance. codeseaueensburv.net -_L• ter,.., - e^7 VISIT OUR WEBSITE FOR MORE INFORMATION Signature o Person espons[ble Date www.aueensburv.net Town of Queensbury*Community Development Office*742 Bay Road, Queensbury NY 12804 w e. Septic Inspection Report Office No. (518)761-8256 Date Ins.-•'• , =• r >a- •. iip f, Queensbury Building&Code Enforcement Arrive: �`,' -part: 1� /��'j",. e m 742 BayRd., Queensbury, ' NY 12804 Inspector's Initis ► �T%/ NAME: �atLi i1�1�, PE' NO.: I —4-- / LOCATION: 9 CLQ ►.CEjT if-C-r-j Qj) IN • - ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/Clay Type of Water: Municipal/Well Water Waterline separation 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. fel Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x L 0Stone Size: ���"' Piping Size Type VG� Building to tank \_— Tank to Distribution Box ‘& © Distribution Box to Field/ PitAA Opening Sealed: Y N End Cap Y N Inlet/Outlet Pipes&Baffles _N Manholes 12"or less below grade -✓ _._._N [provide extension collar if Yes] Y N Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _Y N Engineer Report and As-Built ,Y_N ETU Maintenance Contract _Y N provided Location of System on Property: Front • .r Left Side Right Side Middle Front Middle Rear Yem S . Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Fonns\Inspectlon Fonns\Sept c Inspection Report.03 29 10.doc Septic Inspection Report Office No. (518)761-8256 Date Ins•-••• iv •• Queensbury Building&Code Enforcement Arrive: IC '- •= . 1 4-ern- 742 - -742 Bay Rd., Queensbury, NY 12804 Inspector's I, ' , NAME: 13sr2- r-1- • IT NO.: Zc:-) a" LOCATION: ON: \\- RECHECK: \^RECHECK: Comments and/or diagram Soil Ty•;. •Say• -•.m/Clay Type of Water: - Waterii - •-•ration distance ft. / L `ikc 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 ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Bo - L-y,: h� ?�►� Distribution Box to Field Opening Sea : End Cap Y�N Inlet/Outlet Pipes&Baffles _N/ Manholes 12"or less below grade Y C.-, [provide extension collar if Yes] Y N Location/Separations -- -` Foundation to tank 6itIft. _- Foundation to absorption Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y_N ETU Maintenance Contract Y N provided Location of System on Property: . Front Rear Left Side Right Side MiiIdie Front Middle Rear stem .t • A/4/V, V,-F \2-' V Partial pproved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspeclion Forms\Septic Inspection Repa#_03 2910.doc C 5c Jo 3___p_AA_ - Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: 11 /3/1 / Queensbury Building &Code Enforcement Arrive: am/pm D rt: -c am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 3 V NAME: I J( , [ ( ( ^ PERMIT NO.: l LOCATION: oft � M_ . ��/� INSPECT ON: f/ RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/Clay Type of Water: Municipal/ Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A —h- �.�d�� � Absorption Field: Total length ft. �'l t3 f zy'--> Length of each trench ft. Depth of trenches _ _ ft. Size of Stone Seepage Pits: Number Size: x :+ Stone Size: Piping Size Type Building to tank Tank to Distribution Box 4'`l 6J Distribution Box to Field/ Pit Opening Sealed: _Y_.N End Cap _N Inlet/Outlet Pipes&Baffles _N Location/ Separations • Foundation to tank ft. y'',�i< --Th`—)C) — Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built —Y! N Location of System on Property: Front Rear Le Side Right Side Middle Front Middle Rear s Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc • • A 518-793-2290 m"` Fax#518-793-2115 N° 319 a 4 . E-mail:morningstarseptic@hotmail.corn www.momingstarseptic.corn =WI PTIC •MRVICIN Date: "lit 107 Jewel Road,Gansevoort,NY 12831 TO: cf ( w M M A P e_'. c.3..k_a,jr,...._7__ //. -X -----) THIS pLAN�� BE i pRo JECT SITE A M. TIMES F°R THE aVRefii(i'd AT14N ' H 01 coNsThuc i 111111' ir 9 V- r � J _________ . DSP _c f--1 1pg tt (:*1.% i ,----------- ' s, /A )0 • • -- , TOWN OF QU • ! •, i BUILDING & ♦OIr, , I �4/• Reviewed By 4itL. , 0/ Date: / Eff` r