2008-316 Abki TOWN OF QUE EN SB URY
ifFig742 Bay Road,Queensbtuy,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080316 Date Issued: Tuesday, June 24, 2008
This is to certify that work requested to be done as shown by Permit Number P20080316
has been completed.
Tax Map Number: 523400-295-017-0001-012-000-0000
Location: 845 WEST MT. Rd
Owner. MARJORIE BAILEY
Applicant: MARJORIE BAILEY
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 ci),„,P 4
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: P20080316 Application Number. A20080316
Tax Map No: 523400-295-017-0001-012-000-0000
Permission is hereby granted to: MARJORIE BAILEY
For property located at: 845 WEST MT. 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. Type of Construction Value
Owner Address: MARJORIE BAILEY
845 WEST MT. Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-316
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,June 19, 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 own Que bupr, T rsday,June 19, 2008
SIGNED BY �°( for the Town of Queensbury.
Director of Building&Code Enforcement
/? _/ / FICEUSEOL . , . ���=
TAX MAP NO. PE MIT NO. PE ,
' , ,
PERMIT FEE # i i
APPROVALS: ZONING
TOWN CLERK f ;
r ,.
APPLICATION FOR SEPTIC DISPOSAL 4
SYSTEIV�[PERMI.IT
I .... ..........
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: • d-
INSTALLER: ROf CI
ADDRESS: V J c G•J rnou 4 1/V
ADDRESS: / S 0-drJ5 I / -0
PHONE NOS. ,!, /D
PHONE NOS._. /`i"
LOCATION OF INSTALLATION: W, MOLO r&I
YEAR BUILT NO.OF RESIDENCE INFORMATION:
BEDROOMS X COMPUTATIONS : TOTAL DAILY FLOW
w1980 or older ~ w X 150 gallon r ~ µ f GARBAGE GRINDER
1981 0 or of 1 .._r.»-..... ..X150 llonpebedroom a ( , U�..».~......._.,...� INSTALLED?_•�!_�.
gallon per bedroom a
...1992•present
X
110 gallon per b.»~.edroom _r...~...r.~»~_...~...r.....r.r.~r.. ».». OR HOED?T TUB
PARCEL INFORMATION: rr•r».~..µ»•rrrr•-.•rr•r~»r»r•rrr~ r~r_ .~.»....~~r...~..r IN SPSTAALL
✓ TOPOGRAPHY: FLAT ROLLING
STEEP SLOPE %SLOPE •
_____
✓ SOIL NATURE:SAND LOAM CLAY OTHER
✓ GROUNDWAT R: AT WHAT DEPTH?
WHAT DEPTH? BEDROCK/IMPERVIOUS ____ SAL: AT
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS
FT )
✓ 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).Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK: I40 GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH'__F1
✓ TOTAL SYSTEM LENGTH: FT, SEEPAGE PIT(S): HOW MANY? -eJ-
✓ SIZE OF EACH-&"� FT. X --9"FT. •� _/�
✓ SIZE OF STONE TO BE USED: � � /��0‘�..
# /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO.OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
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i NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN I
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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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 QUESTIONS? CALL 761.8288 OR EMAIL
Queensbury 5°anitar Se Disposal Ordinance. • oodes@.aueenaburv.net
/ // VISIT OUR WEBSITE FOR MORE INFORMATION
f � k- / www;aueensburv.ne
Sign tore of Person Responsible Date
f Town of Queensbury• Community Development Office• 742 Bay Road, Queensbury,NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r-• - r: - -d:
Queensbury Building &Code Enforcement Arrive: : ( "Il •epart: a efirao
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial iC" r
1 -
NAME: A\LE` • NO.: 0S 31 to
LOCATION: 45 v.)E 5T t-16 3 i� t '(Zi) 'ECT ON:
RECHECK:
Comments and/or diagram
Soil TypeCSan' oam / Clay
Type of Water nice a Well Water
Waterline separation distance CAA___ _ ft. > Fps, - a A
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length _ s . ft.
Length of each trench „6-4s`T. ft.
Depth of trenches Z.—2) ft.
Size of Stone I vFI LTRAT69. 5
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank c6G'- 40
Tank to Distribution Box N'1 u +►
Distribution Box to Field/ Pit /�it NC_ To 1 t3 Ft►_TiZ TDC—..
Opening Sealed: ✓Y/ N
End Cap ✓Y/N
Inlet/Outlet Pipes&Baffles „ N
Location/ Separations
Foundation to tank IP) ft.
Foundation to absorption 2.5 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 Re eft Side Rio ht Side iddle Front Middle Rear
m s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
cI
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
•
41 ,,, Community Development Office
1, '� Town of Queensbury • 742 Bay Rd.
Queensbury, New York -12804 PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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