2014-249 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 COMPLIANCE
Permit Number: P20140249 Date Issued: Tuesday, March 15, 2016
This is to certify that work requested to be done as shown by Permit Number P20140249
has been completed.
Tax Map Number: 523400-266-003-0001-041-000-0000
Location: 91 SUNSET Trl
Owner: LAWRENCE & DIANE GAIBROIS
Applicant: LAWRENCE & DIANE GAIBROIS
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 (-- J
property owner of the responsibility for compliance with Site Plan, �d
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
IOW
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140249 Application Number: A20140249
Tax Map No: 523400-266-003-0001-041-000-0000
Permission is hereby granted to: LAWRENCE & DIANE GAIBROIS
For property located at: 91 SUNSET Trl
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: LAWRENCE &DIANE GAIBROIS
91 SUNSET Trl Septic Alteration Residential
QUEENSBURY,NY 12804 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
2014-249
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,June 23,2015
(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 Qu nsbu d.� ,June 23,2014
SIGNED BY - for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Building & Codes Received:
SEPTIC DISPOSAL PERMIT Tax Map ID: a(Q(Q, A -1-V 1
A permit must be obtained before beginning construction Permit No.: — ail
Permit Fee: $ d/
I f,ll4 2. 1 7014 Approvals:
Applicant: 57'2t. 4- i/s /4dA, nn1s InstallerlBuilder ( 7 6;1 t.. • •• // y c1-7•
Address: /3e3. /eh. 9) . Address .30,E r ,, SO ,/ y
t5 4 f1& f o c'4 r'ir, f' �/ZW66 L.50 s►c 7c'�' c� _ -'i�fi7 JU.!• %Z(5-441
Phone: A.LI - Ie7a 7 Phone a13— �6 7
Owner: ).-., 44r7 �j c�/ b(10/3 Location of Installation i'J ji.) t cr 1- ) efe.,
Address: V j Eli t f / /'L ,i
6iieci75 b�,,, , iv,dr JZ8i2/
Phone 2- -
Contact Person for Building&Code Compliance: ,:eee n gi.'d i c l(C„ Day Phone: M'6 JG) 7
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow N D
1980 or older x 150 = Garbage Grinder installed.,
1981 -1991 x 130 = Spa or Hot Tub Installed? 142
1992-Present :,,j x 110 = if/)
Parcel Information:
Topography Flat Rolling _Steep Slope %Slope
Soil Nature Sand Loam .Clay _Other
Groundwater At what depth? i ., 0 Ye g,ea
Bedrock/Impervious Material At what depth? ., ` G, v 60 /'
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is / 80 ft.)
Percolation Test Rate- 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).
] CX%. ' M
Tank size !/00, gallon min'(num size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
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System Type: Absorption Field(with#2 stone) Total length 1,50 ft. Each trench X .3 0
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 Ordinan
Print Name: ,
_ I lit-/Y
't H -1 • f!'d!G Date:
Signature: .. / /IP ,._r.I Date: ./`f- /
Town of Queensbury Bui 'meg&Code -ptic P' posal Permit 518-761-8256
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: 616 l teiaLS Inspected on: QA
Location: (At aka - RAI Arrive: =C)O L'p.m.
Permit No.: ZO 1A 2LAq Inspector's Initials:
1
co, = is and/or dia•ram
Soil Type: Sand/Loam I Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft. M \SS\S6\ " fZSUt1L--\_
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 trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: _Y N
End Cap _Y_N
Inlet/Outlet Pipes&Baffles _Y N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] _Y N
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits t.
Conforms as per Plot P Y N
Engineer Report a As-Buil/f Y N
ETU Maintenance c provided Y N
Location of System on Property:
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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of Queensbury Building & Code Enforcement ) C`° ,
Jrtice No. (518) 761-B256 C i a ?
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Septic Inspection Report
Inspection request received:
Name: q� ctI b Co j S Inspected on: '7 —a—Pi
Location: / I SU (1 S ef '1rQ t I Arrive: ( t i� A- a.m./p.m.
IPermit No.: Li- 2 9Q Inspector's Initials: ►��
Comments an for diagram
Soil Type: 0762Clay
Type of Water: Municipal ell Water
Waterline separation dist ft.
Well separation distance ft.
Other wells: eft.
Well Casing Length 50'+I- Y N N/A
[150'to well required if NO]
Absorption Field: Total length t
Length of each trench jc7 ft.
Depth of trenches '"ILk ft.
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank _ -- , L�Z L�'�`�
Tank to Distribution Box At/I
Distribution Box to Field/Pit
Opening Sealed:
End Cap N
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade _Y
[provide extension collar if Yes] _Y_N �"
Location 1 Separations
Foundation to tank ft. —�
Foundation to absorption
Separation of Pits
Conforms as per Plot Plan Y , p
Engineer Report and As-Built --_Y N k`,t, r �"� `� b
ETU Maintenance Contract provided Y N
Location of S stem+r Pr .e :
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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