2011-100 it
di& TOWN OF QUEENSBURY
Rim"V-1/.1711r 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110100 Date Issued: Thursday, June 13, 2013
This is to certify that work requested to be done as shown by Permit Number P20110100
has been completed.
Tax Map Number: 523400-309-013-0001-033-000-0000
Location: 24 RHODE ISLAND Ave
Owner: ESTHER CAVANAUGH
Applicant: ESTHER CAVANAUGH
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 4 7/„Ctagw.
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.
A./4 TOWN OF QUEENSBURY
41101.11._. 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
1FW
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110100 Application Number: A20110100
Tax Map No: 523400-309-013-0001-033-000-0000
Permission is hereby granted to: ESTHER CAVANAUGH
For property located at: 24 RHODE ISLAND 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: ESTHER CAVANAUGH Septic Alteration Residential
24 RHODE ISLAND Ave Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-100
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,April 12,2012
(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 nsbu •.d ;,A ril 12,2011
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
J) L . Revised 4/14/2010 }
OFFICE USE ONLY --�
307.. 43'1 -_J-� I ( - v(�
z J�6.11,J 1
APR 1 > 2011 ;)�
TAX MAP NO. PERMIT NO. PERMIT FEE
• APPROVALS: ZONING TOWN CLERK JURY
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: .... .
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OFA VALID PER i .
OWNER:,(2.11) 1Q re INSTALLER:iila All
e)).-p ,____
ADDRESS: ,..---171 / / -' "�'"' ADDRESS: 1-/42 / g
PHONE NOS. PHONE NOS. (p 5.471 6 3
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallon per bedroom) GARBAGE GRINDER
1980 or older IK X 150 = &CC INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING ! STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? JV i
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? /yet-
1 DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS /(t3 PER MIINUTE PER INCH[mpi]
(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: /019/9 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: n
❑ABSORPTION FIELD(WITH NO.2 STONE) Total lengthp1.5O ft. Each trench .�-(X 2
c1---
0 SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?_
o ALTERNATIVE SYSTEM Bed or other type?
o 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 761-8256 OR EMAIL
Sanitary Se - Disposal Or•.•.nce. codes(@.queensbury.net
7 i, . /,// VISIT OUR WEBSITE FOR MORE INFORMATION
igure of Person Responsible Date www.queensburv.net
na
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
CL,Lt: 3 (31 r `.
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received: . . 0 //
Queensbury Building&Code Enforcement Arrive: am/pmepart•. :Wpm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: _�
NAME: D• S4Jk\ _ PERMIT NO.: ca 0 I -
67)
LOCATION: /.odc J3 INSPECT ON: /
RECHECK: 5/4;)
�� Comments and/or diagram
Soil Type`�, - Loam/Clay
Type of Water: W /Well Water
Waterline separation distance ft. ,k
Well separation distance ft. .1,6-* E.,......--...1
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft. 1
Length of each trench ft.
Depth of trenches 2tt z. ft. "~ - --
Size of Stone p4Seepage Pits: Number
Size: c p
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box 3Distribution Box to Field/ Pit 4lk
}-ti- e;1,lc?)7
Opening Sealed: N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N 2, v ' �� -
Manholes 12"or less below grade Y N
[provide extension collar if Yes] Y N r z 2L —v""/
Location/Separations . . isoft_ara.A.- -rt....s —
Foundation to tank ft.
Foundation to absorption !1 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 Rear Left Side Right Side Middle Front Middle Rear
s��m Use S tusUse S tus:
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\Septic Inspection Report_03 29 10.doc
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r -°' Septic Inspection Report G a7 -
dim
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ Depart: cim/13m74 2 Bay Rd.,Queensbury, NY 12804 Inspector's Initials. . �, ;.
itis •
NAME: 1, -Jae. at-31/1 PERMIT NO.: ICI — act
LOCATION: _ al * A. . i' - i r "(-- INSPECT ON:
RECHECK:
S Comments and/or diagram
Soil Type: San. / Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: _ft.
Well Casing Length 50'+/- Y N N/A qA.c2xtAA---
[150'to well required if NO]
Absorption Field: Total length '`-.-CS _ ft. OCZLVY-5C--C?
Length of each trench ft.
Depth of trenches 442.,t- 't--t ft.
Size of Stone iPq4PV1/,--Cr7--t/VCCIIS
Seepage Pits: Number
Size: . x4, . . . •
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box eg.l
Distribution Box to Field/ Pit
Opening Sealed: Y N <C4-1N--V--
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade Y N c?... ,----i-------tr..x.d...,ve_____rze,rt____,
[provide extension collar if Yes] Y N
rza•--frt..(Ax.--t-4.--1- 12—,
Location/Separations
pa
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits __ ______ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built ,.T,_..,..Y N
ETU Maintenance Contract Y N
provided y
<-- °s6 -3(")
......,t_tfre2..1,..x..C, ....--.
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
stem Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspecton Forms\Septic Inspection Report03 29 10.doc
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