2012-294 ..41" TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120294 Date Issued: Monday, June 18, 2012
This is to certify that work requested to be done as shown by Permit Number P20120294
has been completed.
Tax Map Number: 523400-309-010-0001-044-000-0000
Location: 10 PINE St
Owner: JOHN & SHARON O'HANLON
Applicant: JOHN & SHARON O'HANLON
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 1
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.
AO` TOWN OF QUEENSBURY
..4742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
V.
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120294 Application Number: A20120294
Tax Map No: 523400-309-010-0001-044-000-0000
Permission is hereby granted to: JOHN& SHARON O'HANLON
For property located at: 10 PINE St
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: JOHN& SHARON O'HANLON
10 PINE St Septic Alteration Residential
QUEENSBURY, NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2012-294
Residential Septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 14,2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town o ue sbury; hur P ay June 14,2012
SIGNED BY 1 for the Town of Queensbury.
Director of Building&Co. Enfo' ment
Revised 4/14/2010
OFFICE USE ONLY
�jyJUN142012
TAX MAP N030 9 1IYH (PERMIT NO. I ,;/1 S c) PERMIT FEE .
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT. �j(, �p `71 `
OWNER: �O I1 i-j C - 't (-r r •-o�41 0 11/Lflcl INSTALLER: K V ( C �' `/--w C �'C/(/•'' `"c L-pk
ADDRESS: I r T J u 6' -51-1- Ci`�iG e lADDRESS: �,� 4 V '77'64el r /y4. I Ai 4
p '
PHONE NOS. 7 l x'- i=',.2i=',.2$TpPHONE NOS. .---? -5 O (0 Z 7 C. 1 7 2 U
LOCATION OF INSTALLATION: /0 iI Ve 5T
--
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X (Gallons per bedroom) = TOTAL DAILY FLOW • GARBAGE GRIND R
1980 or older X 150 = 3 o 0 INSTALLED? D
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? i C2
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE •i.'.
r %SLOPE
I SOIL NATURE: SAND 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: I v00 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: ( (
XABSORPTION FIELD(WITH NO.2 STONE) Total length r)5 ft. Each trench 02X
O SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑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.
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 Ordinance. codes a)queensburv.net
�" C fr V// L VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www•queensbury.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
fr )
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: (C)--i 5H .
Queensbury Building &Code Enforcement Arrive: am/pm Departl i c am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: �'
ICA-y)
NAME: O 44-an f)J PERMIT NO.: f a--A 9
LOCATION: /) Pi'f)C 5-t INSPECT ON: Lo 5—la
RECHECK:
Comments and/or diagram
Soil Type: nd oam / Clay
Type of Water: M al/ Well Water l e1 t .14
Waterline separation distance lc A e eft.
Well separation distance /V 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 ^1—. 7 __ ft.
Size of Stone his,rel,
Seepage Pits: Number
Size: x
Stone Size:
PipingSize Type 9V� .
Building to tank '�—� �� ��A- ✓�'�
Tank to Distribution Box
Distribution Box to Field / Pit tzG.-u
Opening Sealed: N
End Cap , Y_N
Inlet/Outlet Pipes &Baffles N
Location/ Separations
• Foundation to tank ft.
Foundation to absorption ''l2 ft.
Separation of Pits ft.
Conforms as per Not951a Y/� N
Engineer Report ants-Buil ,_p(f N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S -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
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