Loading...
2008-360 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Pemit Number. P20080360 Date Issued: Monday, July 28, 2008 This is to certify that work requested to be done as shown by Permit Number P20080360 has been completed. Tax Map Number. 523400-297-017-0001-016-000-0000 Location: 59 MEADOWBROOK Rd Owner. GUY & BARBARA LA SELVA Applicant: GUY & BARBARA LA SELVA This structure maybe 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, Gam' 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: P20080360 Application Number. A20080360 Tax Map No: 523400-297-017-0001-016-000-0000 Permission is hereby granted to: GUY & BARBARA LA SELVA For property located at: 59 MEADOWBROOK 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: GUY &BARBARA LA SELVA Septic Alteration Residential 59 MEADOWBROOK Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name 1 Address Electrical Inspection Agency IBS SEPTIC IVAN BELL 2 LOWER WARREN STREET QUEENSBURY,NEW YORK Plans &Specifications 2008-360 SEPTIC ALTERATION RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,July 03,2009 (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 T ee ur ,July 03, 2008 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement ____-__---= OFFICE USE ONLY- _ TA MA �N ERMIT NO. PERMI�' ' f APPROVALS: ZONING TOWN CLERK '" x 0..-__--___-•------------------------- -------------------------- ' i= - -- -=_ APPLICATION FOR SEPTIC DISPOSAL SYSTEM ' ; ; L.l A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: ZINSTALLER: i �A ADDRESS: � � /r/DRESS: 7 C.t. /\ PHONE NOS. / PHONE NOS._ y LOCATION OF INSTALLATION: f10(ti NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW 1980 or older X 150 gallon per bedroom = GARBAGE GRINDER INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rollin g—>--�' Steep slope %Slope ✓ SOIL NATURE: Sande Loam Clay Other ✓ GROUNDWATER: At what depth?—4& ✓ BEDROCKIIMPERVIOUS MATERIAL: At what depth? PA ✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is 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: ! G ❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total lengQft. Each trench X �� ❑ 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 these and all requirements of the Town ofCQUESTIONS =MORE R EMAIL Queensbury Sanit Sewage Disposal Ordinance. codet WEBFORMATION ww Signa of Person Responsible Date = Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury,NY 12804 £A=�' B 5-LGL 6(06 x t ry V 1 3 t r r i T YCe= y T + F 7 ta Septic Inspection Report Office No. (518) 761-8256 Date Ins ction r uest received: -7 o K Queensbury Building &Code Enforcement Arrive: m/p gegart: am/pm 742 Bay Rd.�eensbury, NAY 122804 o Inspect is n i I : lam NAME: �l �,,� /PERMIT NO.: �J�" LOCATION: ' -� INSPECT ON: cs2 5 RECHECK:,. Comments and/or diagram Soil-Type: Sand / Clay Tpe of Water: Municipal/ eR Water Waterline se arati istance 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 V ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Sizq1T Building to tank �j J Tank to Distribution Box u 41 Distribution Box to Field Pit y' L Opening Sealed: N End Ca Y N Inlet/Outlet Pipes&Baffles Y N Location Separations Foundation to tank r7D ft. Foundation to absorption ft.— Separation of Pits ft. Conforms 4 per Plot Plan N Erk0geer,Wand As-Built Y N Location of System on Property: Front ar Left Side Right Side Middle Front Middle Rear System tat Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc Jot..,) 06 ! J / 1 I 1 j G 0 /G � Ft e? � TO © —f-- I i t f i