2009-570 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development- Building 8t Codes (518) 761-8256
+ ER.TIFI%-,ZXA %,J.UCOMPLIANO"T"
Permit Number. P20090570 Date Issued: Monday, November 29, 2010
This is to certify that work requested to be done as shown by Permit Number P20090570
has been completed.
Tax Map Number. 523400-296-010-0001-017-000-0000
Location. 29 OAKWOOD Dr
Ownen BULLARD FAMILY TRUST
Applicant: BULLARD FAMILY TRUST
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
1 �
Issuance of this Certificate of Compliance DOES NOT relieve the
owner of the responsibility for compliance with Site Plan,
property P P
Variance,or other issues and conditions as a result of approvals b the
PP Y Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals,
TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090570 Application Number. A20090570
Tax Map No: 523400-296-010-0001-017-000-0000
Permission is hereby granted to: BULLARD FAMILY TRUST
For property located at: 29 OAKWOOD Dr
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 QueensburyZoning
Ordinance. Type of Construction Value
Owner Address: BULLARD FAMILY TRUST Septic Alteration Residential
ROBERT F. BULLARD TRUSTEE Total Value
29 OAKWOOD Dr
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-570
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,November 20,2010
(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 Tomm of Qu nsb ry; ` r' ,November 20,2009
SIGNED BT for the Town of Queens
bury.
ury.
Director of Building&Code Enforcement
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OFFICE USE ONLY # ;' '
OERMIT
TAX MAP NO. PERMIT NO. r FEE
APPROVALS: ZONING TOWN CLERK-
------------- ...... rrrr--------
APPLICATION � -� rrrr rrrr
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FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBT4AINED BEFORE WORK B INS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. � ,t
OWNER: /V INSTALLER: TR
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ADDRES ! ddfADDRESS:` y 60 C -'CJ- U"-r' /
PHONE NOS. PHONE NOS. A�_L9
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling. Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCKAMPERVIOUS MATERIAL: At what depth&
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is �Zzt 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).
TANK SIZE: /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 ft. Each trench X
t f
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? 'd ZA
Tank size? Number of tanks?
....................................................:..................................................rrrr..,.,...,.....,.,............
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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 unman nr k trran+^,4 .^ •^"^���
i
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection requ c
Queensbury Building &Code Enforcement Arrive: t e�Initial
pm rt: O:Z� m
742 Bay Rd., Queensbury, NY 12804 Inspector's
NAME: SU 14 r-, MIT NO.:
LOCATION: , INSPECT ON: — —0
RECHECK:
Comments and/or diagram
Soil Ty oam/ Clay
Type of Water:(Muniq2 ell Water
Waterll ration distance ft.
Well separation distance ft.
Other wells: ft. Bu
RUILT
Well CasingLength 50' + / - Y N N/A AS
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number 2-
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box L4"I
Distribution Box to Field Pit %
Opening Sealed: N
End Cap Y N
Inlet/Outlet Pipes &Baffles v1Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot N
Engineer Report an -Bui Y N
Location of System on Property:
Front Rear eft Side Right Side Middle Fro Middle Rear
System Use S
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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"IN I
TOWN OF AS QUEENS 0
BUILDING & D BUILI
Reviewed By*
Date:
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