2012-184 TOWN OF QUEENSBURY
w
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120184 Date Issued: Monday, October 21, 2013
This is to certify that work requested to be done as shown by Permit Number P20120184
has been completed.
Tax Map Number: 523400-301-006-0002-089-000-0000
Location: 3 SWEETBRIAR Ln
Owner: DAVID CANN
Applicant: DAVID CANN
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
property owner of the responsibility for compliance with Site Plan, /
Variance, or other issues and conditions as a result of approvals by the f r
Direct f ut ing Co• • .`ement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120184 Application Number: A20120184
Tax Map No: 523400-301-006-0002-089-000-0000
Permission is hereby granted to: DAVID CANN
For property located at: 3 SWEETBRIAR Ln
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: DAVID CANN Septic Alteration Residential
3 SWEETBRIAR Ln Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2012-184
Res Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, April 24, 2013
(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 Town of Queensbury; Tuesday, April 24, 2012
SIGNED BY �1 * for the Town of Queensbury.
Director of Building&Co4. nfe7. Bement
•
I). Revised 4714/2-010'
/14/201 Q 1
OFFICE USE ONLY i
TAX MAP NO43 )1, ( ,— '-p?PERMITNO. 1��) g y PERMIT FEE l�J 3 2��L
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,O,•� F A VALID PERMIT.
(�
OWNER: Wtll'L, CM r\ C\ INSTALLER: T. I0 "J seo ipt ( /
ADDRESS:i=n S w e P L\cjl' f o r . ADDRESS: i'1' , L.0 uv-e,\J\ U r(P n S a• U-# r`it,)v r
PHONE NOS. 1 -]') +b 12. PHONE NOS. 1(Oil
1/ki
LOCATION OF INSTALLATION: 43 Svvee i r i U r
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X (Gallons per bedroom) = TOTAL DAILY FLOW • GARBAGE GRI jNj ER
1980 or older X 150 =
INSTALLED? `v1\
1981 -1991 .1 X 130 = 1 9 n SPA OR HOT TUI,)lIir
1992-present X 110 = INSTALLED?
PARCEL INFORMATION: ,
r
•/ TOPOGRAPHY: FLAT ROLLING J STEEP SLOPE N c %SLOPE I
/ SOIL NATURE: SAND J LOAM lV 1k CLAY IV I\ OTHER_IV h
✓ GROUNDWATER: AT WHAT DEPTH?
/ BEDROCK/IMPERVIOUS MATERIAL AT WHAT DEPTH? \\C
`C( I"T1
'
/ DOMESTIC WATER SUPLY: MUNICIPAL j WELL\\ \\(If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS N \\ PER MIINUTE PER INCH[mph]
(Test to be comple ed 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: 1()4 n _ 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: 1
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length lc�' rft,.` Each trench , !X 5 0
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? \ }i\ Size? V 1\
❑ALTERNATIVE SYSTEM Bed or other type? V ! I
o HOLDING TANK SYSTEM Total required capacity? Iv I,\ Tank size? (V ' t Number of tanks?IV 11.
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 ':ge Disposal Ordina codes(squeensburv.net
f C pl XI 4 +1I -I /___ VISIT OUR WEBSITE FOR MORE INFORMATION
Sign• ,re of Pers a Re 6nsibie Date www•queensbury.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
toe_A,(\escIrt: 9-- i I (.1e:1 ,1(1)
. .
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: ‘1.--c21-1 a.
Queensbury Building &Code Enforcement Arrive: am/pm Depart: / _ -gym/pm
742 Bay Rd,, Queensbury, NY 12804 Inspector's Initials: ' ,_ ` a (.�` 1L k__
NAME: A 4 PERMIT NO.: i a
eco — I 0 y
LOCATION: .`3 S Lk)e -k-k r'ta r INSPECT ON: it--a S-- /a.
RECHECK:
Comments and/or diagram
Soil Type: all, Loam / Clay
Type of Water: Municipal/Well Water
Waterline se•aration distance , � ' �� � ft.
Well separation distance ft.
Other wells: � ��' ��''_ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ‘Z.- 6 ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone -CD-`Z
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank kc ,?
Tank to Distribution Box `� ,(,-
Distribution Box to Field/ Pit 't 5a-4 - r
Opening Sealed: . _N
End Cap a Y ,__N
Inlet/Outlet Pipes & Baffles r! Y N L fl-k r
i
Location / Separations , t,4) $1-)70\-1.0-1\.,),‘
- $1 \ v �.i`
� �
•
Foundation to tank ft.
Foundation to absorption 2_ ft.
Separation of Pits Aft.
Conforms as per Plot Plan i/ N
Engineer Report and As-Built . Y N
Location of System n Property:
Front Re Left Side Right Side Middle Front Middle Rear
System Use Status:
"%i 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
S \AItei ricer
w UA e
t� �e
tom A' 3 S weer br i a r
M �
f\
p \eQ\toll\,
� 1 a\e c ,�5 A n e.�,s�',,
5-+S 0
\
\AZI
LoN'Crc. eA,5 cti* -
1 R.w_5\-4,\,.
\(�- - x `\
S c�Z�Zb P;c t'`1\ck
�^ Za 9e�' C1\- � \ �7
•
Sc For q ifc 0 X17? �� ;,N
5'ec
_i