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2010-570 TOWN OF QUEENSBURY Fors742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20100570 Date Issued: Tuesday, December 14, 2010 This is to certify that work requested to be done as shown by Permit Number P20100570 has been completed. Tax Map Number: 523400-301-020-0002-064-000-0000 Location: 55 QUEEN MARY Dr Owner: DOROTHY KEMP Applicant: COOKS SEPTIC 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 f property owner of the responsibility for compliance with Site Plan, �q 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. 1 ;41111A TOWN OF QUEENSBURY *TS 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20100570 Application Number. A20100570 Tax Map No: 523400-301-020-0002-064-000-0000 Permission is hereby granted to: COOKS SEPTIC For property located at: 55 QUEEN MARY 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: DOROTHY KEMP 55 QUEEN MARY Dr Septic Alteration Residential QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications BP 2010-570 Septic Alteration for 51, 53, and 55 Queen Mary Drive(shared system) for a total of 6-units $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,December 14,2011 (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 Tow nsbt T erda ,December 14,2010 r SIGNED BY �^y �� for the Town of Queensbury. Director of Building&4.•- E s`.rcement _90-/o- t96�-i jl / �3►� 7°"I ry/ a0/� '96 �(.ad-a-�`�' (� s3 X51 r Q ix tyvk A4C,T? 0,Zio-C__ 1 Revised 4/14/2010 OFFICE USE ONLY g } i J TAX MAP NO. __ _PERMIT NO. PERMIT F �j.-� • 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 pc A VALI PE MIT. t OWNER: (`,/L,.-pt'6,P G"[ Z'/�! dna ; INSTALLER: 4,(.":9/ c i jJ ADDRESS: ,3 3'.55" - �'+v�fn Me y`J ADDRESS: /9 y ` # A /� f\� PHONE NOS. 151i 5-'5,ate{ 6:2`" `eJe° /� ��PHONEQNOS. (G? Y f�" t pc LOCATION OF INSTALLATION: e;/),, IVa/✓ bY.�.�1w�if S g `'> / rac„ 7�f1�5 e� `v 4 - 4, RESIDENCE! Sit YEAR BUILT NO.OF COMPUTATION X = TOTAL DAILY FLOW ((11 �7y BEDROOMS (Gallons per bedroom) GARBAGE GRINDER "� 1980 or older X 150 = INSTALLED? 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLIN Y STEEP SLOPE %SLOPE / SOIL NATURE: SAND ' LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? NICC ,/ BEDROCK(IMPERVIOUS MATERIAL: AT WH T EPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE 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: .�-c(' 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. et- iiik SYSTEM TYPE: (:3� ���N-VO., J�1�� ❑AB RPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench � X:15 .20i � SEEPAGE PIT(S)(WITH NO.3 STONE) How many? li Size? ei y,?jI t--e-5' I a ALTERNATIVE SYSTEM Bed or other type? c\--$ a 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 the nd a requirements of th T n o ueensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Se aape Dispyisal Ordi codes{a!queensburv.net // / VISIT OUR WEBSITE FOR MORE INFORMATION www.queensbumnet Sign q `rs'6n Responsible Date own of Queensbury*Community Development Office*742 Bay Road, Queensbury NY 12804 - 3 'la-ea-7 - Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: - 3am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 7[� /� -` NAME: PERMIT NO.: 10 5 /0 LOCATION: 6-3 ()mot,- Marl INSPECT ON: ,7- / (--) . RECHECK: Comments and/or diagram Soil Type. San / Loam/Clay / Type of Water: 'ipal/ Well Water P- /2 �Z — (:),cWaterline 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. \ *-1/,'.`�v�`i Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x ' ,A Stone Size: Piping Size Type w Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: _Y—N End Cap Y.__.N Inlet/Outlet Pipes&Baffles Y_N Manholes 12"or less below grade _Y 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 Ni 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 Middle Front Middle Rear stem Use S us: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection ReporL03 29 10.doc Septic Inspection Report Office No. (518)761-8256 Date Ins .. ► • Queensbury Building&Code Enforcement Arrive: 1 -1 a► a 41 •m 742 Bay Rd., Queensbury, NY 12804 Inspecto's Initial • / - NAME: C_JEEs 1 V3‘CI-P-.1( 1' ` RMIT NO.: 1 o—\570 LOCATION: 1tsTJ7 WV-VI �1 't ` Ec- INSPECT ON: 1 Z- 1 Q--1 C) R K: - .. 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. Length of each trench ft. Depth of trenches `ft. Size of Stone Seepage Pits: Number ----� L: - Size: x _ Stone Size: Piping Size Type Building to tank Tank to Distribution Box D' J Pit ,c Opening Sealed: Y N End Cap Y N NK:7'4> Inlet/Outlet Pipes&Baffles Y_N Manholes 12"or less below grade Y—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_,. 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