2013-161 OW, TOWN OF QUEENSBURY
742 Bay Road,Queensbury, NY 12804-5902 (518) 761-8201
41.11.
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130161 Date Issued: Monday, April 29, 2013
This is to certify that work requested to be done as shown by Permit Number P20130161
has been completed.
Tax Map Number: 523400-315-006-0001-004-000-0000
Location: 700 CORINTH Rd
Owner: MARION ELDER LIFE USE
Applicant: MARION ELDER LIFE USE
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 (�
aN7-i°
property owner of the responsibility for compliance with Site Plan, �v+
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
- "
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
FAT
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130161 Application Number: A20130161
Tax Map No: 523400-315-006-0001-004-000-0000
Permission is hereby granted to: MARION ELDER LIFE USE
For property located at: 700 CORINTH Rd
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: MARION ELDER LIFE USE
Septic Alteration Residential
BONNIE FRANCETT& DAVID ELI; p
700 CORINTH Rd Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans&Specifications
2013-161
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 26,2014
(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 Tow of Que nsbu /J F r a • . 26,2013
SIGNED BY � for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
APP. ? 5 7013
Office Use Only <‘-4,to
TAX MAP NO. 31 5,Lo -PI PERMIT NO. f/ 3- ) ( PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE `WnORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: IV1 USI (Ar E l`3i' r INSTALLER: 1` e S SC�rti
ADDRESS: 100 Lac i r,�l" 9 i N ADDRESS: 1 1 0Cwe rW G (- P r\
PHONE NOS. -Ig,- ') l \ 6 PHONE NOS. -196- 0/'t aj I
LOCATION OF INSTALLATION: —1 QD Co C i ni L M.
RESIDENCE INFORMATION:
NO.OF COMPUTATION TOTAL DAILY FLOW
YEAR BUILT BEDROOMS X (Gallons per bedroom) GARBAGE GRINDER
1980 or older 3r X 150 = 1-1-1..)- 0 INSTALLED? IV IA-
1981 1981-1991 I r X 130 = I\1 ! 1 SPA OR HOT T�1�
1992-present I V rT X 110 = 11)rf INSTALLED? I�H
PARCEL INFORMATION: 1 r
✓ TOPOGRAPHY: FLAT ROL G ✓ STEEP SLOrPE\V ()- %SLOP�Ef f P 1 f
✓ SOIL NATURE: SAND LOAM\U Ilt CLAY IV !It- OTHER \V fr
✓ GROUNDWATER: AT WHAT DEPTH? ,U I\
\.\
f `k✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT EPTHt?\+ . I 1✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL I`I 1 (If well:water supply from any septic system absorption is: ft)
I PERCOLATION TEST: RATE IS V k 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: 1(Y3( 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 PE:
ABSORPTION FIELD(WITH NO.2 STONE) Total length ZD 0 ft. Each trench +I X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many?i )V Size? V
o ALTERNATIVE SYSTEM Bed or other type? IV
`/ t
o HOLDING TANK SYSTEM Total required capacity? It.
( Tank size? 'V Number of tanks? 1
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 regulati e s with respect to this application and agree to
abide b. th-se .•d al -quirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
S.•i1' N
.. I '.• sal Ordinance. codesOqueensburv.net
i✓/ I /// ', / VISIT OUR WEBSITE FOR MORE INFORMATION
Signatur • Pe Xn Responsible Date www.queensbumnet
672/o
Septic Inspection Report
Office No. (518) 761-8256 Date Ins on r-• .- •: 03-S
Queensbury Building&Code Enforcement Arrive: ^7I) . ilagrO.-part: =? a •
742 Bay Rd., Queensbury, NY 12804 Inspect6r's Initi. T�
NAME: '`la\ �t , P ' IT NO.:
LOCATION: -700 �4� '-INSPECT ON: l 3
RECHECK:
Comments and/or diagram
Soil Type $an oam/ Clay
Type of Water Munici a Well Water
Water ration distance 1 e ft. t- �Q ti A ,N..�)
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 7 DC ft.
Length of each trench W e=ft. t= ;-Y) ��u@Eer ul, c_t\4\Q.S_PL
Depth of trenches -1-7 ft. .Y V
Size of Stone 2_
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank " ;r c k yO
Tank to Distribution Box << pJC--
Distribution Box to Field/ Pit 4.1'
Opening Sealed: N
End Cap N t
Inlet/Outlet Pipes&Baffles VY_ iv
Manholes 12"or less below grade 1, yyN
[provide extension collar if Yes] 1/Y N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft. , ,�
Separation of Pits �fE. .
Conforms as per Plot � N
Engineer Report and -Bu' Y T N
ETU Maintenance ract Y N
provided — —
Location of System on Property:
Front $ar Left Side Right Side Middle Front Middle Rear
System Use S us:
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\Sepdc Inspection Report03 29 10.doc
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APR5 2013 : (.301(c) q. Q C� a r� ' 1
TOWN OF
�• a BUILDING & 7, , .. PT.
Reviewed B : L
Date: lG
511111-0-5---1-° 121
HAVE SEEN OR OBSERVED ALL OBJECT
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AS HOUSES,WELLS,TREAVE PERSONALLY F
SHOWN ON THIS DOCUMENT.I HAVE DIAG 1� R' ir i J"; €1 \ I�.
MEAS ' 1 H' )ISTANCE SET FORTH ON 1 �, 9 y_
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