2014-099 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: P20140099 Date Issued: Friday, April 11, 2014
This is to certify that work requested to be done as shown by Permit Number P20140099
has been completed.
Tax Map Number: 523400-301-013-0002-014-000-0000
Location: 4 BRAYDON Ave
Owner: SACCENTE JEANNE
Applicant:
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 Director of Building&CIe En • cement
Planning Board or Zoning Board of Appeals.
•
TOWN OF QUEENSBURY
`4i� 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140099 Application Number: A20140099
Tax Map No: 523400-301-013-0002-014-000-0000
Permission is hereby granted to: STEPHEN CHASE
For property located at: 4 BRAYDON Ave
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: STEPHEN CHASE Septic Alteration Residential
JEANNE SACCENTE Total Value
4 BRAYDON Ave
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2014-099
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, April 11,2015
(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 Town Quee bury /Jji ri• . , /, 1,2014
`rV/ 4
SIGNED BY � for the Town of Queensbury.
Director of Building&Code Enforcement
ECEod1
ffat Community Development Office ? 0 g 2014
Town of Queensbury • 742 Bay Road • Queensbury, NewYrr t28
Office Use Only TOWN OF QUEEIMStUNY
`I / L/ Q BUILDING&CODES
.3
TAX MAP N0. b 3 " o� 17 PERMIT NO. J . 0 /9 PERMIT FEE to
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.
OWNER: J� Cti"C CC Cr L^�'IC INSTALLER: aftriArG & t -cc Se,-i„ c
ADDRESS: V tee�](�- D 1‘1 Are ADDRESS: g goo y C,/p M1/ ca/X ✓ -
PHONE NOS. -5-(k�k - Tt7 - 7t9 y 0 PHONE NOS. -7G79,2 - 7u 7
LOCATION OF INSTALLATION: [��G t //�G7,
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? A0
1981 -1991 `L X 130 =
Z6a SPA OR HOT TUB
w
1992-present X 110 = INSTAI I FO?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLUNG IX STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND 1`(- LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? N11
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? "tit
✓ DOMESTIC WATER SUPLY: MUNICIPAL X WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS r 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:/an/ 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:
:ABSORPTION FIELD(WITH NO.2 STONE) Total length/25 ft. Each trench X -3
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
D ALTERNATIVE SYSTEM Bed or other type?
❑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 7614256 OR EMAIL
S ry Se Dispos dinance. / codes(dqueensbunmet
/ /y VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.queensburv.net
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Septic Inspection Report / Il ��✓// ( �/,y�
Office No. (518)761-8256 Date Ins•>•• •n -. 11 9 It
Queensbury Building&Code Enforcement Arrive: "r1 Crt rt: \. Ir, p
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia s:
NAME: _AC Po' rt,NO.: / 1 y
LOCATION: (Z!\/1TCrUJ A tC : INSPECT ON: L IR
RECHECK: I(
Comments and/or diagram
Soil Type. Loam/Clay
Type of Water: unid I Water F to, IptQ/
Wate ine separation distance 4 ft.
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 2S ft.
Length of each trench `1t,_ft.
Depth of trenches 7i\ ft.
Size of Stone ��
Seepage Pits: Number _
—
Size: x
Stone Size:
Piping Size Type
Building to tank L}%% 5 f kit Ap t ri\c--
Tank to Distribution Box lYt` p(L-fj hDistribution Box to Held/ Pit fiu /, e-7jC-j'h g(� .-Opening Sealed: N
End Cap ,/ _N
Inlet/Outlet Pipes&Baffles_ t4N
Manholes 12"or less below grade _ _ N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank `ZZ ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y_N
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y_N
provided
Location of System on Property:
Front dr Left Side - .r' Middle Front Middle Rear
m S s:
Approved
Partial Approved and needs to be re-Inspected, please call the Building&Codes Office
Disapproved
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Date: