2008-289 TOVN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
4z Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080289 Date Issued: Wednesday, June 11, 2008
This is to certify that work requested to be done as shown by Permit Number P20080289
has been completed.
Tax Map Number. 523400-239-008-0001-029-000-0000
Location: 32 BOATHOUSE Rd
Owner. WILLIAM & LYNNE MASON
Applicant: WILLIAM & LYNNE MASON
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
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
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080289 Application Number. A20080289
Tax Map No: 523400-239-008-0001-029-000-0000
Permission is hereby granted to: WILLIAM & LYNNE MASON
For property located at: 32 BOATHOUSE 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. Tyne of Construction Value
Owner Address: WILLIAM & LYNNE MASON
P.O. BOX 85 Septic Alteration Residential
CLEVERDALE, NY 12820-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-289
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,June 10, 2009
(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 Tcyw�t Queens ry; T esday,June 10, 2008
SIGNED BY ( for the Town of Queensbury.
Director of Building Co nforcement
wner's guide: httl2://www.epa gov/npdes/pubs/homeowner guide Iona customize pdf
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APLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER:_ �«l/�j/'� c L}//y 4E i")4-S o A) INSTALLER:
ADDRESS: �O me 0, ADDRESS: ]tea X-ax st'S- C i.� ✓Er��/ge E" Al
C- 4,6 Vs 2 0/3 -F- - zx7
PHONE NOS. C,� HONE NOS. C— S-b —915 73
LOCATION OF INSTALLATION: _
RESIDENCE
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
BEDROOMS
1980 or older X 150 gallon per bedroom = 150 GARBAGE GRINDER
1981 -1991 0 X 130 gallon per bedroom = INSTALLED? ✓o
1992 present X 110 gallon room = Q OT TUB
INS MAD
/ LE��T
PARCEL INFORMATION: �F/ C..A R(�+.) � p
✓ TOPOGRAPHY: FLAT ROLLING, STEEP SLOPE SLO %
✓ SOIL NATURE: SAND LOAM_ OTHER_
✓ GROUNDWATER: AT WHAT DEPTH?_,' 5/ r BEDROCK/[MPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: SK t f L-y reo
MUNICIPAL WELL (If well:water supply from any septic system absorption is:( ft) 46)
✓ PERCOLATION TEST: RATE IS PER MIINUTE 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: C o 0 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.
STEM TYPE:
❑A PTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench-X
SEEPAGE P T( H NO. 3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM r other type?
❑HOLDING TANK SYSTEM Total required capacl Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPEC Y 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 Quee any permit or approval
granted which is based upon or is granted in reliance upon any material misrepresentation or failure to m 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 QUESTIONS? CALL 761-8256 OR EMAIL
to abide by these and all requirements of the Town of Queensbury codes@gueensbury.net
Sanitary Sewage Disposal Ordinance.
VISIT OUR WEBSITE FOR MORE INFORMATION
www.ciueensbury.net
tZZe 'D V
Signature of Person Responsible Date
Town of Qteensbury • Community Development Once • 742 Bay Road, Queensbury, NY 12804
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No.......... -' . .�.:Cem 2 1117 8 Cut-in Card No.....................................
Owner..........rAAa.A)...Dl. w. ..P rC..............................................................................................
Location..................�0 A I-1 lcr � ��• . .......
........................................................................ ...............� ...
Installation Consisting of.... .....: ��s1. TZ..... ..................
�.....��7/zoLs
....................................�........° va....'......................................................................................................
....................................................................................................................................................................................
Installed By.......C.�......eA�2—...............................................Lic.No...................................................
...... ....................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of maki spections at any time, and if its
rules are violated,the Company shall have the right t re o e t c ificate.
z-u 9 �
Date.............................. .................. INSPECTOR..........:..... ........................................... ..........................
Member N.F.P.A.,I.A.E.I.
Septic Inspection Report
Office No. (518) 761-8256 Date Ins io est received:
Queensbury Building &Code Enforcement Arrive: a /pm part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: �j
NAME: Sc PERMIT NO.: —Z_l
LOCATION: r c% INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ 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
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 O
Building to tank
Tank to Distribution Box u wt
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Ca N
Inlet/Outlet Pipes&Baffles Y N
Location I Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front ear Left Side Right Side Middle Front Middle Rearms 'Jrr
S t 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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