2014-641 TOWN OFQ UEENSBURY
•
742 Bay Road, ucensbury NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140641 Date Issued: Monday, December 22, 2014
This is to certify that work requested to be done as shown by Permit Number P20140641
has been completed.
Tax Map Number: 523400-302-014-0002-010-000-0000
Location: 17 DIXON Ct
Owner: MARK K REICHEN
Applicant: MARK K REICI-IEN
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 (7.2)1,.?,,,,P ,, /it--
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&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
, 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
F.4la
Community Development- Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20140641 Application Number. A20140641
Tax Map No: 523400-302-014-0002-010-000-0000
Permission is hereby granted to: MARK K REICHEN
For property located at: 17 DIXON Ct
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: MARK K REICHEN Septic Alteration Residential
17 DIXON Ct Total Value
QUEENSBURY NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
FRED SMITH
23 VERMONT Ave
OUEENSBURY.NY 12804
Plans&Specifications
2014-641
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,December 18,2015
(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 o Quee
j ilia i a l. 1_• •tuber 18,2014
SIGNED BY Si, for the Town of Queensbury.
Director of Building& Code Enforcement
Community Development Office • CEL 1 d 2014
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only .K1.--1-04.1,
(��L-Q T/ ��/P o
TAX MAP NO. t'_30 o� ,( �t - D - 1 0 PERMIT NO. I 7PERMIT F ,,,ad--
,, d-- e�Z.--------
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.(} APPLICATION IS SUBJECT TO REVIEW FORE SUAN E OF A VALID PERMIT.
OWNER: ,i4 ,4 R ea el INSTALLER: OC' i l
t.
ADDRESS: /'7 0 r /02-1 &I ADDRESS: //1-7/7 077-71 U-� 4/,5 V
PHONE NOS. 0,5'l /q--- i 7/ PHONE NOS. 36/ 4 9,S.-6,
LOCATION OF INSTALLATION: )—2 L;,k/A-i LI
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINITR
1980 or older `., X 150 = 30 a INSTALLED? N
1981 -1991 X 130 = SPA OR HOT TVpA
1992-present X 110 = INSTALLED? Al
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT PkOLLING ' STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? Ar P
✓ BEDROCK/IMPERVIOUS MATERIAL: AT W,HA/T DEPTH? N"+
r
✓ DOMESTIC WATER SUPLY: MUNICIPAL (, WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS lfil PER MIINUTE PER INCH[mpil (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: / Z) 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. fp Stip P
SYSTEM TYPE:
,ABSORPTION FIELD (WITH NO. 2 STONE) Total length 15 0 ft. Each trench c." X c0
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑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 e��n all r irements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sa '.vy�( DIspo al Ordinance. codesequeensburv.net
�/l �� yP- 24?- VISIT OUR WEBSITE FOR MORE INFORMATION
�JC i
S' aturie f'Person esponsible to
www.queensbury.net
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received: _
Name: Nr K R Cin P A Inspected on: 0"
Location: 1 O i'b/t aot1 f'-E" Arrive: �� •.m�p
Permit No.: 'y I Inspector's Initials: ,�
ot�ments and/or diagram
Soil Type: Sand_.o.II Clay !//
Type of Water. Municipaell Water
Waterline separation distance ft. �.�a aT 'AM
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+1- Y N N/A
[150'to well required if NO]
Absorption Field: Total length I(QO ft.
Length of each trench ft. E p �o c V u�l SAF b1"a vN
Depth of trenches 3- ft• CA AP-,C.om_
Size of Stone -Z_,
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank y « 6CtA\AO
Tank to Distribution Box 4\I OR-21c-
Distribution
RahDistribution Box to Field I Pit \/1' ►c � Tp y"
X35
Opening Sealed:
End Cap /Y N �p LJJa?p v31 \,� �-
Inlet/Outlet Pipes&Baffles IY
Manholes 12"or less below grade N
[provide extension collar if Yes] Y—N
Location/Separations
Foundation to tank \CD ft.
Foundation to absorption ft.
Separation of Pitsft.
Conforms as per Plot Plan ✓Y N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided _Y_N
Location of S stem on Prose •
Front Rea eft Side '••htSide 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
. .
\ :".' - ,_ ---- • - . , 17-
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• •• • - .. SEPTIC PLOT PLAN
-....
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH4eStJ,ES. WELLS. TREES, FENCES. ETC
Qi3.7" SHO, Tir DO MENT.I HAVE PERSONA LY 1
• 1 ,'DIST.... SET FORTH ON
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Reviewed By
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