2014-056 to TOWN OF QUEENSBURY
I 10%1
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140056 Date Issued: Wednesday, March 26, 2014
This is to certify that work requested to be done as shown by Permit Number P20140056
has been completed.
Tax Map Number: 523400-295-014-0002-023-000-0000
Location: 75 MT. VIEW Ln
Owner: ADAM M PALMER
Applicant: ADAM M PALMER
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 ( L�//
property owner of the responsibility for compliance with Site Plan, s�/ K
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
V742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140056 Application Number: a20140056
Tax Map No: 523400-295-014-0002-023-000-0000
Permission is hereby granted to: ADAM M PALMER
For property located at 75 MT. VIEW 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: ADAM M PALMER Septic Alteration Residential
75 MT. VIEW Ln
QUEENSBURY NY 12804-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
STONE INSTALLATIONS
232-6707
4305 STATE ROUTE 50 •
SARATOGA NY 12866-0000
Plans &Specifications
2014-056
Res. Septic Alteraion
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 14,2015
(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 To of Q nsb ;011 F. • / ' • h 14t 2014
i
SIGNED BY \ for the Town of Queensbury.
Director of Building& Code Enforcement
Office Use Only
Town of Queensbury Building & Codes
Received: 2014 i
SEPTIC DISPOSAL PERMIT Tax Map Il ;� 13 95.fkl -a-
Permit No.: — 054
A permit must be obtained before beginning construction
Permit Fee: $
Approvals:
Applicant: Stob t n 5/CLI/o. //oi?S InstallerBuilder L5 H.0 ars/a//A 7 oh s
Address: if 3n j X.*C- SD Address ,30 . ,. o
6arzr-oc4. 5p�"rn5s1Air1X866 �f[.f0 u frni f,,r/t.lZR'4
Phone: a38-j 4707 Phone 2jJ- 471/7
Owner. laI4m RI m e r Location of Installation 75 �0on1/y 4.4"1 LA ,
Address: 7S- moon, --Ih czo tar
aucensbur4. .Y 7ZSo9
Phone 77/- /8t/ /I J _,- /'
•
Contact Person for Building&Code Compliance: ��G.,n ?firthCR 5 oncJ-n5 /4ti� �o/7fDay Phone: 4101-1707
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older x 150 = Garbage Grinder installed? 710
1981-1991 x 130 = 350 G,�J Spa or Hot Tub Installed? j?o
1992—Present x 110 = —
Parcel Information: X
Topography Flat Rolling _Steep Slope %Slope
Soil Nature Sand LoamClay Other
Groundwater At what depth? /l/oryr fill er7/11"
Bedrock/Impervious Material At what depth? // I/
Domestic Water Supply X Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- 3 per minute per inch(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).
exiftfag
Tank size /'!i DOC gal n(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type:✓r Absorrp on Fie ailla.#44,03 e- Total length / 0:7' 6
8 0 ft. Each trenchX
Seepage Pit(S)(with#3 stone) How many? Size?
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. There will be no exceptions.
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 Sanitary
Sewage Disposal Ordinance. j--77/ / �[
Print Name: Gk n re 64 /Ci Date: 15-5li
Signature: u� iA Date: 3-7,f7_/r
Town of Queensbury Buildin /s///Codes is posal PemrR 518-761-8256
ueensbujy Building & Code Enforcement //,,
/
0 Ice No. (518) 761-8256 *Pill
Septic Inspection Report c)- -//r-
Inspection request received• 31 17/ _e.,y
Name: H taIlmCr , C
ti. lr�pr Inspected on: 3 I
Location: /K.
NI't,d,e,0kai-C- Arrive: f _ _ a.m./p.m.
Permit No.: SOILE—65 Inspector's Initials: iiila
Comments andlor diagram
Soil Type: .a 2 . I. lay
Type of Wa el--IMunicipa ell Water
Waterline separa ion distance ft.
Well separation distance
Other wells: I\CIHft.
Well Casing Length 50' +/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length It ft.
Length of each trench 0 ft.
Depth of trenches 2 ft.
Size of Stone /Mi-,1 C1/41-0-16 CO
Seepage PitsNumber
Size: r Ilk
Stone Size:
Piping Size Type ` (�
Building to tank ����1 �WY,�
Tank to Distribution Box ikxt -1'-3>)
Distribution Box to Field/Pit / cu— Aq0{ _5
Opening Sealed v/Y N `tom
End Co /y N
Inlet! utl Pipes&Baffles '(Y N
Manholes 12"or less below grade Y N
[provide extension collar if Yes] _Y_N
Location/Separations -y
Foundation to tank ft. '�' \'5,x],�-a-%—
Foundation to absorption j ft.
Separation of Pits )(litft.
Conforms as per Plot Plan N
Engineer Report and As-Bui ) N
ETU Maintenance Contract provided Y N
Location of System ea.E operty:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use Stat :
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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fAREA (15552.7811904286 . }5.F)' ' j • 4 y h,F ' Q Town BND
PERIMETER 508.937161518057 K• `� AA1111Ac • } L*U 4 - tl Q Roads
.011 PARCEL_ID 1295.14-2-23 p } . e of` '4 S #' -3• I ❑J Queensbury Parcels
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SEPI IG FLU I FLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHO ON THIS DOCUMENT.I HAVE PERSONALLY p3 (Y 'u_O 54a
MEASURED E DISTANCE .f ORTH ON THIS DIAGRAM. l
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