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2010-323 TOWN OFQ UE E NSBURY Bay 742 y Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20100323 Date Issued: Monday, July 19, 2010 This is to certify that work requested to be done as shown by Permit Number P20100323 has been completed. Tax Map Number. 523400-309-013-0001-068-000-0000 Location: 24 INDIANA Ave Owner. THOMAS MC GOVERN Applicant: DEBORAH MCGOVERN 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 %� / 14' property owner of the responsibility for compliance with Site Plan, �" V 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 " TOWN OF QUEENSBURY Fitzcsi 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20100323 Application Number. A20100323 Tax Map No: 523400-309-013-0001-068-000-0000 Permission is hereby granted to: DEBORAH MCGOVERN For property located at: 24 INDIANA Ave 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: THOMAS MC GOVERN 4 1/2 FAIRVIEW St Septic Alteration Residential SOUTH GLENS FALLS,NY 1280 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2010-323 $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,July 09, 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 thekTown ue b y; f pa r_ . • ,July 09, 2010 SIGNED BY \ for the Town of Queensbury. Director of Building&Code Enforcement c OFFICE USE ONLY ii 7/259- 5� c�� �3- -(,� /0-,523 TAX MAP NO. '3 . � PERMIT NO. PERMIT FEE r APPROVALS: ZONING TOWN CLERK 1 R f 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: ;BA\- V� �,\E j INSTALLER: P\\ \- - t' --\ 0-E--- ) ADDRESS: 7 \-� \ i v\ krAC,(A R`i -- ADDRESS: PHONE NOS. k-AU'Ck"-`kr:*t C) PHONE NOS. r1 i 7 LOCATION OF INSTALLATION: L_-'\ \ i 0 \ c\ 'A A') I�A1:E. NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = ® INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED? PARCEL INFORMATION: 0 t.-T-'-_ `• E.c. ---c-- ) --5 �� .-VD 7— ✓ TOPOGRAPHY: Flat rolling 4 Steep slope %Slope `a ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth? k"\W-4K)EN) 01Z1 ✓ 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 ‘ — ..F 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 licensedrofeslo al engineer or architect(unless installed in a Planning Board approved subdivision). E-XV-T1 to TANK SIZE: Z GALLONMIN. ( 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: �, Eli-v-v to ti fc\ D F 1A 110(_D 0 M t F U_____ © A ORPTION FIELD (WITH NO. 2 STONE) Total lengthft. Each trench X I BlifSEEPAGE PIT(S) (WITH O. 3 STON� s How many? Size? - ICJ O ALTERNATIVE SYSTEM Bed or other type? O 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. lumpi TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL P6RMIWF QUEEN ami t # RECEIVED Fee Paid a' ? Date: A'(,)- i `q 7 NOV 19 Reviewed By LOCATION OF PROPERTY FOR INSTALLATION: S76t-; iPG4 C95P « fv Owner' s Name: �-�� i r � � C Lim �_� .�>ttC',•;, : Owner' s Mailing Address: ! k• i./ ( , / - (14' Installer' s Name: Phone #: 1L- c,- G. Number of bedrooms (if residential ): r �� .f- Total daily flow (residential-compute @ 150 gal . per bedroom): =r-t-` Topography-Circle One: /FTa£ Rolling Steep Slope % of Slope Soil Nature-Circle One: Sand Loam Clay Other /Depth: Ground Water-At What Depth? Feet Bedrock or Impervious Material-At What Depth? Feet Percolation Test-Circle One: of Re wired' Required/Rate Min. Per Inch Domestic Water Supply-Circle One: (MunicipaT`)Well Other If domestic water supply is a well - Separation: Water supply from any septic absorption feet PROPOSED SYSTEM: Septic Tank /2_-5 gal . (Minimum size: 1,000 gal . ) Tile Field: Each Trench feet//Total System Length feet Seepage Pit(s) : Number of / / Size each: ft. x ft. Size of Stone to be used: # -3 / Depth or Thickness a2- c feet ************** HOLDING TANK SYSTEM IF REQUIRED No. of Tanks Size\of Each Gal . Alarm system and associated electrical work to be inspected by a certified agency. **************** I have read the regulation on the reverse side of this sheet and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: L-`' DATE: cam"- ' f Septic Inspection Report Office No. (518) 761-8256 Date Ins.-ction r-• e •• - - =:: Queensbury Building &Code Enforcement Arrive: = _"i '• ►-part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: / C NAME: OF 2x0c \-li MCCIv F.Q►> PE'MIT NO.: 10 — G2... LOCATION: _24 ki3OtA1JN A F I SPECTON: tR— Z — tO RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal/ Well Water � t�� Waterline separation distance _ ft. c :_ Well separation distance ft. "'�-"`�'�' - Other wells: ft. Well Casing Length 50' + / - Y N N/A 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 Box Distribution Box to Field/ Pit Opening Sealed: _Y_N End Cap _Y_N Inlet/Outlet Pipes &Baffles _Y_ N Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _Y N - .)1 V2 ,� .AF `A Engineer Report and As-Built Y_ N * t7 t� - -)tii"`f_ Location of System on Property: Front Rear Left S . Right Side Middle Front Middle Rear System Use Statyls:-t .,' •roved ,f ial Approved and needs to be re-inspected, please call the Building &Codes Office D isapproved / Las -- ised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc atv:e_ 0\k--T-0 Mit-SAStz"*4- Septic Inspection Repo Office761-8256 -. No. (518) Date Inspection r ,y�� Ned• Queensbury Building &Code Enforcement Arrive: \=2.N • �,� - .•rt: 1 = 5\-60\ 6\)‘' - •ti Inspection Report ' ' ve- Office No. (518) 761-8256 k_E5 `S •ate In .- ion r=: received: Queensbury Building&Code Enforcement Arrive*•* >.,+� . - 5 • I. Depart: __AMC 742 Bay Rd., Queensbury, NY 12804 Inspector's Initia . NAME: , 1 CGA)E e 6 PERMIT NO.: 10- LOCATION: _ r _ 11".�E INSPECT ON: — r RECHECK: ' fkrPtv _ • an. •r .i..r.m Soil Type: Sand Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. C���j��v \ is 1? E-e 6i Other wells: ft. Well Casing Length 50' +/ - Y N N/A [150'to well required if NO] A �C i \O to lc; Absorption Field: Total length ft. a� \c �1 Length of each trench ft. D 0r,(Z:T CU Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x — C- C EC PEg\C Q\c u Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: _Y T 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 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 em se S . us: Approved Partial Approved and needs to be reinspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Repoit03 29 10.doc Z— Septic Inspection Report Office No. (518) 761-8256 Date Inspectign request received: Queensbury Building &Code Enforcement Arrive: '- "btJ am/ Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: ^() 1P.s1 �� PERMIT NO.: LOCATION: J ��l.�-,�� tioe INSPECT 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. 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 Distribution Box to Field/ Pit /�r`Opening Sealed: _Y N //%Je/ /i7rd End Cap Y N 1 Inlet/Outlet Pipes&Baffles Y—N moi/ ceCCG iA e k'J 103` ri I d Manholes 12"or less below grade _Y_N [provide extension collar if Yes] Y N O'roi/ I Va Zdierh 0,/�� ahP Location/ Separations C61/ r s/e ms 44-12-.36/`4, Foundation to tank ft. `� s�a Foundation to absorption ft. 1 f vii/ P14. 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 Middle Front Middle Rear System Use Status: 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 Report_03 29 10.doc - t 107 HAN ' -Da ) ruitlew V1:7:::`,EtI2k2.k-1 T, Glens FA.115 , ,...., . ,i;41-i. ,, Poel — DtLeRe3. el c GelitAN 1 . .., Egadt_____ --"C__ —`_ --- 1.• ------ -, - -- __ _,---. , _ ;-‘,, .? 6 0 Y ' 7 OF OUEENSBU RECEIVED - . a "1 have seen ot hbwild,f811111111111111MIlehidence of, NOV 1 9 1992 3! all objects such as hountIltdb,be krces, etc., 1 . -ZI shown on this documeht.I Aliso represent that I haveD 0 0 ---_, . personally measured tlho distances set forth on the diagram." t9 G & CODE DEPT >1 i ( 1 . •AllibiAtham.' - 1—le—VC) KW SIGNAT1pRE DATE 31 o! IZ oh eRt tielsoti . / . , (fli Rote. a o . , - — 0- ,, HOU5e- " i - ) r -----,, TOWN OF<QUE7 1St, :`'Y' ,.,, i II „ .. , BULDING 0 OD l '-'* ,P,ifit./11 ,;----- '. 7- . -- , , 4 R ...„4/ 721 eviewm'd Date! _...._____JiL ---4-2---(1f4 7 , 1 / I Z i CD SCI-C— Datt9it._ L )/ 1, . ( ) i,,,v(o ' ...,, \ c:„.11-- il4:4S l-. f., ,/- , ,,z1 4,3LI-3\b1\ . tr, i'-' %'Y (0 /115z-ceAa RI- . ‘ , tLeo.ON 01_.5 I , i 1) ST„,,,,,,9 e B.;,Ich*,..” , , . I c) F- iiTt)t -,t. il L t_ [ TOWN. OF QUEiNSBURY 60 / BI-' '; NG A DEPT. , ..--. REVi EVV.E. BY ,14--- .."---4-4-- ti.4-i-------- 30. eroaRa S DATE I/p7/?z, _,, Septic Inspection Report Office No. (518)761-8256 Date In •- ion • ' •. • Queensbury Building&Code Enforcement Arrive: &r ,.=part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspecto s In' NAME: i lCl f��E NO.: 10 —3 LOCATION: Z44 I i0 )l I )/ /9\JE SPECT ON: tO 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 Length of each trench ft. �vsebbk Depth of trenches ft. Size of Stone 0 Seepage Pits: Number Size: Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: _Y T 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 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 System Use Status: proved 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 ReporX_03 29 10.doc Septic Inspection Report Office No. (518) 761-8256 Date Inspection request • • iv=: Queensbury Building &Code Enforcement Arrive: 2-,"-00 a kgr -•.- : am/pm 742 Bay Rd., Queensbury, N`Y 12804 Inspector's Initials• NAME: M t��.7(k1 — v tJ ' RMIT NO.: F --?)Z--27LOCATION: 1 = \I INSPECT ON: 47-55 —t 7 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] LK) tO\)Eb -A ctV91 Absorption Field: Total length ft. Length of each trench ft. '� ,� J 365 _s Depth of trenches ft. Size of Stone —1 Q (K� b \AE t3) Seepage Pits: Number Size: t)1 --fN Stone Size: v 't� Piping Size Type 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 ,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 Status: pproved 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 Repor03 29 10.doc /0"" ,54-72 (.....---C-Ic )\ \ tt-j2cL,,..1---,6-6 kf"1lt--Wf._ %.,,,jr-V174-±v.,_ v--) --A ,10, rt ge Nue - t 1,17 Hat,/ NTC:j ‘ A- --v--- :'.,;--:.•.,, i 7? Glens F...115 c2\---- -5-t .,:-5-\-;-,,b2;,---E • - - 10, "419 - De-Loaf:O. Plc GoveRne 44. -'' :•'-'''• _____Vet_____IS;) _ f_RaNt ___________.. .._ ,. _ ..t..0,7__ -). .. 1.kr:ii\:_ i\> .:A., --_.;s7_----u_c), , v ,* ,, fy 0 6 V . . /4 8 i'os Ab2,___Avew.ver_ 2- '2-, -\.) ° CI .vN OF OLIEENSBu RECEIVED "I have seen ord1914.0101116611111i111111111vidence of, NOV 1 9 1992 3! all objects such as hod*,silk Inin.fumes, etc., 1 -Z shown on this documeit I also represent that I have 0 '..DG. & CODE DEPT ail personally measured ti distances set forth on the diagram." 0 SIGNATURE DATE ' ,..... _...„. _ , 0, • 0, R oheRt PieLsofi cOi a o . . • R 0‘ ,.......__ 0- s House_ - /2/ 1 ..----, , \ I TOWN OF -QpE m4.4 i ,/ BUILDING ,t;), OD/_* .,,, 1_,,,,-i ;______. .... i. J \ \ ... i i !0 Reviewed it!: /Ag1.77 l'..: . .41/L.- • . / i Date: • i ',. ( I j V JZ &) 6°A-C—Dtgri C__ idt),$-IKI ( \\,..'. 7c (----, 0 ' v--•-iyA -\--i,t.. i i) ill% 54,0v., . 1 1— %'Y to 1364eAat Ptv . i 0-, ao' I', \, t \ ,,, L, • L t t Feld 1,1 \ 4....‘, i i . , Srop0,9 e 811AL09 It ___\4'1 1 i - I v)l \\,______ Z I 0 I- (-)11-.) ,CL fl-1k [ _ i ! -v---ii\ii 10._--: i-A-4 It\ P•1) ' TOWN OF QUEENSBURY 60 / BL!!!....Tns:Ci ril. cCici.,ES DEPT. * '"--1 _ rf : REVIEWEDBY - - 1 nATF if f71?Z — -,--,- 0,...f00 a.Ft.o. ill a II e pi y