2015-199 ...0111ft TOWN OF QUEENSBURY
Bay
742Queensbury,NY 12804-5902 (518)761-8201 Road,Queensb �'
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150199 Date Issued: Thursday, May 28, 2015
This is to certify that work requested to be done as shown by Permit Number P20150199
has been completed.
Tax Map Number: 523400-296-009-0002-029-000-0000
Location: 13 CEDARWOOD Dr
Owner: ALMON & JOYCE BARTHOLOMEW
Applicant: ALMON & JOYCE BARTHOLOMEW
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
ci)J4
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 QUEENSBURY
.4,11116101
V$1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150199 Application Number: A20150199
Tax Map No: 523400-296-009-0002-029-000-0000
Permission is hereby granted to: ALMON& JOYCE BARTHOLOMEW
For property located at: 13 CEDARWOOD 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: ALMON &JOYCE BARTHOLOMEI
13 CEDARWOOD Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-199
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, May 26, 2016
(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 T n o een 'V 4 ay 26,2015
SIGNED BY ' for the Town of Queensbury.
Director of Building&Code Enforcement
!J I I�`
Town of Queensbury n 7 2 Say.RQ ueensbury, New Yor,� 12804
IIII MAY 26 15 .. t are -icy l
Office Use Only
�
TAX MAP NO. 2-L 1 -2 fl ?F C2UEENS p C\
PERMIT NO. PERMIT FEE
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: N_-. C,1,1"-\,-\(,.\ 101",1 it/.../ INSTAL IFR: --L ) 5_erp-i , C
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ADDRESS: `e Vl Ur W et()3 Or. ADDRESS: 1 V V r)W ?r oe r .3-
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PHONE NOS- t)3' 1 Y 6 6 PHONE NOS- c I 'J-1 J
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION TOTAL DAILY FLOW
YEAR BUILT BEDROOMS X (Gallons per bedroom) GARBAGE GRINh��
1980 or older I X 150 = % ! i' r) INSTALLED?
1981 -1991 I X - 130SPA
INSTALLED? N
�^ � _ SPA OR HOT TU
\ t
1992-present \V.
X 110 -
PARCEL INFORMATION:,/ TOPOGRAPHY: FLAT ROLL G STEEP SLOPE\\I \\ %SLOPE\V \\
IN
✓ SOIL NATURE: SAND LOAM�� CLAY N OTHER \�
✓ GROUNDWATER AT WHAT DEPTH? \\1
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA EPTH? 1,�
./ DOMESTIC WATER SUPLY: MUNICIPAL WELLU'(If well:water supply from any septic system absorption is: ft)
• I PERCOLATION TEST: RATE IS PER MIINUTE PER INCH(mpij (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 Pia Hing Board approved subdivision).
TANK SIZE: II n1)iJ eGALLON(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 PE:
ABSORPTION FIELD(WITH NO.2 STONE) Total length 10 O ft Each trec� X�_
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? \l Size?
❑ALTERNATIVE SYSTEM Bed:or other type? f 1 \
❑ HOLDING TANK SYSTEM Total required capacity? ,'�1 n Tank size? N‘ 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 -.uirements of the Town of Queensbury / QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Se :. • rx.-al Ordinance. c'-- f)-1
- L C f codes0cueensburv.fe•c
_ r- VISIT OUR WEBSITE FOR MORE INFORMATION
Signatu • off,'n •esponsible Date www.cueensbuni.r:
�}"k u
Town of Queensbury Building & Code Enforcement \po0�
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received: �t3 t tS
Name: Xv' +'c \QVY\R-YJ Inspected on: 5Vit 12-0-A5
Location: 13 C L(AC Y VwooCI Arrive: - � �•: �..m.
Permit No.: "�cl� Inspector's Initials: ,=�'
•mments and/or dia•ram
Soil Type: S .0 Le;• / -y
Type of W. -r: Municis. : - . er tc As+Pr�
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 "2-oU ft.
Length of each trench 11/9„6"D ft. •
Depth of trenches Z- 1 ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank E`iV►51` t>.- 6 y"
Tank to Distribution Box b Q C-7
Distribution Box to Field/Pit
`1‘ hVt)Q-3 /i-U ��e 1:)V e--31 5'7
Opening Sealed: v/
End Cap VY N �,:
Inlet/Outlet Pipes&Baffles p N r1t q1.
Manholes 12"or less below grade Y ti
[provide extension collar if Yes]
Location/Separations
Foundation to tank EY15 i 1,6 ft.
Foundation to absorption ?C) ft. c —ecE1
Separation of Pits ft.
Conforms as per Plo rr— Y
Engineer Re and A -Built
ETU Mainte e Co provided Y N
Location of S stem on Prose :
Front R-.r Left Side Right Side Middle FronMiddle Rear
S stem Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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