2012-532 TOWN OF QUEENSBURY
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742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120532 Date Issued: Wednesday, November 14, 2012
This is to certify that work requested to be done as shown by Permit Number P20120532
has been completed.
Location: 32 HERALD Dr
Tax Map Number: 523400-308-010-0001-042-000-0000
Owner: KRISTINE ORR
Applicant: KRISTINE ORR
This structure may be occupied as a:
Septic Alteration Residential By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy 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 Planning Board Director of Building& Code En`cement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Qutxcnsbur.y,NY 12804 4902 (518)761 8201
Community Development -11ttilding& Codes (518) 761-8256
BUILDING PERMIT
Permit Number 1>20120532 Application NLIMI-)cr: A2012052
Tax Map No: 523400-308-010-0001-042-000-0000
Permission is hereby granted toKRISTINE OI R
For property located at: 32 HERALD Dr
in the Town Of QUCC11SbUry, to construct or place
at the above location in accorda rice wide application together with plot plans and Other information hereto filed
and approved in compliance with, the NYS Uniform Buding(,'odes and the Qucensbun,Zoning
Ordinance. Type Of COnSMICti0ti Value
OwncrAddrcss: JOEL R BROWN Septic Altercation Residemial
DANIELLE C BROWN Total N"alue
32 HERALD Dr
QUEENSBURY NY 12804-0000
Contractor or Builder's Name / Address E'lectrical Inspection Agrency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
OUEENSBURY, NEW YORK
Plans&Specifications
2012-532
Res. Septic Alteration
540.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, November 13, 21113
(If a longer period is required,an application fear ran extension as be made to the code Enforcement O,fficer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Tuesday, November 13,201.2
SIGNED BY
for the'rown of(,)ueensbur.\,
Director of Building& ( ode lunforcenaent
Revised 4/14/2010
OFFICE USE ONLY
pp p ?? , � 2012
TAX MAP NO.36 3 . I 0-1 �PaMIT NO. I —5J RMIT FEE yQ"____ NOV0V 0
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.. 1
OWNER: ( 4i ' /�-F / 1 r) '"' 0Icir INSTALLER: -_,Z. /3 v/ ,
ADDRESS: 3 !,/` C.(- (7 i-) /0 V.- ADDRESS: 1. 01.:,-/ -e-v- GJ C v-1- t - y 69:1\i/l/
PHONE NOS. 7 61 Y� 6 X -'(••2 PHONE NOS. 7 q , -,T/ ? L/ -
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT
NO. X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older * X 150 = '" INSTALLED? •
1981 -1991 X 130 = SPA OR HOT TUB
1992-present 77 X 110 = 7 -2,U INSTALLED?
PARCEL INFORMATION:
/
✓ TOPOGRAPHY: FLAT ROLLIN • STEEP SLOPE %SLOPE •
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? t.3 PC
✓ 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[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: '.v G 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 TY E: _ i
ABSORPTION FIELD(WITH NO.2 STONE) Total length SLC: ft. Each trench L'f X 17) C
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
(2-2-1.---\, -e,1 VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.queensburv.net
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
hurdtc / `30p.
Septic Inspection Report - O -
Office No. (518) 761-8256 Date Ins io -• ' riled:
ed:
Queensbury Building &Code Enforcement Arrive: L.-, a'r/p D- rt: \ @ 5- am
iutir
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials _
C i
NAME: r P MIT NO.: )--.5- 3,
LOCATION: ..3 .i-n IY 1 d- D r NSPECT ON: //•— g ' /,;,
RECHECK:
Comments and/or diagram
Soil Ty • oam/ Clay
Type of Water u •.1' Well Water
Wate '• -a. '• •istance 1��_ ft."k—
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 „ZIT ft.
Length of each trench '&_,.;61_,__-N ft. GL , 0c; —7c_vg
Depth of trenches 3T o' ' .1�
Size of Stone z_
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank til <,c1-'k Lj-n E .,\- .,L
Tank to Distribution Box L' I. (")vL
Distribution Box to Field/ Pit L1 'i N C_ T t. Litt QCRF W L
Opening Sealed: Y/ N
End Cap k/1( N F p:Np \_0 L ,A; C='il-\'- )
Inlet/Outlet Pipes&Baffles ' •
Manholes 12"or less below grade -- _ N
[provide extension collar if Yes] Y— N
Location/ Separations
Foundation to tank ffv..1tiTr;,:#�#, tOi
Foundation to absorption - -Z L ft.
Separation of Pits ft.
Conforms as per PIo n N
Engineer Report and s-Bui — N AS BUILT
ETU Maintenance Contract Y_ N
provided
Location of System on Property:
Front Rear -ft Side Right Side Middle Front Middle Rear
system Use Stat .:
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
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5 jPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY �- _- _
MEASURED THE DISTANCE /FORTH ON THIS DIAGRAM. ' 13),-/ U-c... (.4)C ,/J
SIGNATURE DATE
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