2012-555 TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120555 Date Issued: Monday, November 26, 2012
This is to certify that work requested to be done as shown by Permit Number P20120555
has been completed.
Tax Map Number: 523400-301-012-0003-029-000-0000
Location: 32 PROSPECT Dr
Owner: DEBORAH W TITUS
Applicant: DEBORAH W TITUS
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 Dire oro uildin & o�• orcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
(EL 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120555 Application Number: A20120555
Tax Map No: 523400-301-012-0003-029-000-0000
Permission is hereby granted to: DEBORAH W TITUS
For property located at: 32 PROSPECT 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: STEFAN& ROMICA SUCIU
Septic Alteration Residential
32 PROSPECT Dr
QUEENSBURY NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
OUEENSBURY.NEW YORK
Plans&Specifications
2012-555
Septic alteration-tank only
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, November 26,2013
(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; Monday,November 26,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010
OFFICE USE ONLY
TAX MAP NO2b I, I a� 3 ERMIT NO. ERMIT FEE"-- -e--6-/----- 7-121 --) ))/..-0---)
6n I
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. .r
OWNER: DA r U "rlAV` INSTALLER: S ; r
�N( --
ADDRESS: � ee —C. ADDRESS: Z LO\/✓P C y n,
PHONE NOS. l_5 f O TS v
�� 4 PHONE NOS. � )D�� d 1
LOCATION OF INSTALLATION: Jc-)-- P 'C _ 1,,..
RESIDENCE INFORMATION:
NO. COMPUTATION
YEAR BUILT = TOTAL DAILY FLOW
BEDROOMS X (Gallons per bedroom) GARBAGE GRI
1980 or older X ' 150 = 4-c n INSTALLED?
1981-1991 X 130 = SPA OR HOT T B
1992-present X 110 =
INSTALLED? t' '
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLVNG STEEP SLOPE\\11)1 %SLOPE,\I •
✓ SOIL NATURE: SAND LOAM IVr CLAY IV OTHER ft-
✓ GROUNDWATER: AT WHAT DEPTH? \\I
\1
✓ BEDROCK/IMPERVIOUS MATERIAL AT WDEPTH? !V it
✓ DOMESTIC WATER SUPLY: MUNICIPAL `/ WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS l 1 PER MIINUTE PER INCH[mpi]
(Test to be co)npleted 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: SOC 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: r R�
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length 1V ft. Each trench N ()--(u
x N N
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? N Size? 1)V
❑ALTERNATIVE SYSTEM Bed or other type? J \\I I 1
11
n l
❑ HOLDING TANK SYSTEM Total required capacity? \ N Tank size?_ : Number of tanks? I\(
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,d all requirements Ordinance. of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Se�QjcodesCa)queensburv.net
�' I -- 6—11/ VISIT OUR WEBSITE FOR MORE INFORMATION
Sign • f Person Responsible Date www.queensburv.net
Town of Queensbury* Community Development Office* 742 Bay Road, Queensbury NY 12804
, P( '(\c)k`ct D-- J
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection requz. - ved.
Queensbury Building &Code Enforcement Arrive: 7 = l .
0 a • pm i_D:•-rt: 7 = ZL armpm�
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:�4-
NAME: TFF .) ' 'MIT NO.: / £
LOCATION: , '3 rf6S p�� SPECT ON: / / 0 /�
RECHECK:
0V_ crvLY
Comments and/or diagram
Soil Type: ER"• ., Loam/ Clay
Type of Water: M nici y/ Well Water
Water i - -.. . . distance 614 f ,.T ra
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 trenchesft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank !J"x,51- j c y " bc_N up
Tank to Distribution Box 1-4,1k +ate_ To a A5-1-1.1 )(==,
Distribution Box to Field/ Pit
Opening Sealed: ✓Y N
End Cap YN
Inlet/Outlet Pipes&Baffles N/
Manholes 12"or less below grade _Y �iV --- r•�E� Mme„ dV F F_-_)c\-- ..6,�4
[provide extension collar if Yes] TY_ N
Location / Separations
Foundation to tank \ "�` ft.
Foundation to absorptione.
. ,-5T-ft.
A S BUILT
Separation of Pits
Conforms as per Plo > N
Engineer Report a As-Buil Y— N
ETU Maintena -c C rasrtf ct _Y_ N
provided
Location of System on Property:
Front 11:# Left Sid- Right Side Middle Front Middle Rear
System Use S . s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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SCALE:
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SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON T�IS DOCUMENT.I HAVE PERSONALLY
MEA.URE1,H./IIST • E SET FORTH ON THIS DIAGRAM.
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