2008-410 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20080410 Date Issued: Tuesday, August 12, 2008
This is to certify that work requested to be done as shown by Permit Number P20080410
has been completed.
Tax Map Number: 523400-239-007-0001-025-000-0000
Location: 139 ASSEMBLY PT. Rd
Owner: MARY TRELLO LIFE USE
Applicant: MARY TRELLO LIFE USE
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, " lot
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: P20080410 Application Number. A20080410
Tax Map No: 523400-239-007-0001-025-000-0000
Permission is hereby granted to: MARY TRELLO LIFE USE
For property located at: 139 ASSEMBLY PT. 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: MARY TRELLO LIFE USE Septic Alteration Residential
ANTHONY TRELLO Total Value
82 MAIN Sq C
HUDSON FALLS,NY 12839-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-410
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, August 07, 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 reTow �f* kry ay,August 07, 2008
SIGNED BY for the Town of Queensbury.
7�
Director of Building&Code Enforcement
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L=i., OFFICE USE ONLY '
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APPROVALS: ZONING TOWN CLERK_ ;
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APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT}
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
_ c
OWNER: % y INSTALLER:
ADDRESS: f C� �L ��/ ADDRESS: � L/. r J//
PHONE NOS. -:6664 PHONE NOS. �� SI t
LOCATION OF INSTALLATION: Z A ��_ r J
........................................................................... ........................................................... RESIDENCE INFORMATION
YEAR BUILT NO.OF X COMPUTATION= _ TOTAL DAILY FLOW
;
I............................................... ......BEDROOMS,......I...........k' ; r .i GARBAGE GRIN E
1980 or older X i 150�Iallon per bedroom = ' I INSTALLED?
............................................:....................� -. ,...................;..............,..g.............R..............,,....................a,.,........I......3'0.l...^............................................I
1981 1991 X , 130 gallon per bedroom , {
t I = i SPA OR HOT TU8
j...................:..........................................................,..............t..........,a..............................,:.............,...............,......................;.........,....,................................
..........,.,.............,;
1992 present X j 110 gallon per bedroom INSTALLED?
PARCEL INFORMATION: /K
✓ TOPOGRAPHY: FLAT ROLLING'- STEEP SLOPE/ Z %SLOPE. ` l
✓ SOIL NATURE: SAND LOAWd- 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 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 TANKJN�r_GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELQ: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH.. T. X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OP THICKNESS_C'LFT.
✓ BED SYSTEM_SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH ANDJOR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH l�
✓ GALLONS./TOTAL CAPACITY: GAL.
......:..::................................... ..,..::,.,,, :.,:,,:.:,..i
il 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 S? CALL 761-8256 OR EMAIL
agree to abide by these and all requirements of the Town of
Queensbury Sani ry Sewage Disposal Ordinance. COUO"T'oc-:'odes§ciueonsbury.not
SIT UR BSITE FOR MORE INFORMATION
www.aueensbury.net
Signa ure of Person Responsible Date
QTown of Queensbury • Community Development Office - 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/gym part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: �� PERMIT NO.:
LOCATION: f q INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand oa C
Type of Water: Municipal Well ater
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + J - Y N N/A
Absorption Field: Total length A--
Length of each trench Ak
Depth of trenches ft. ����;' Loco
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping ize Type
! -
Building to tank
Tank to Distribution Box kA
Distribution Box to Field/ Pit KITA 'TT)
Opening Sealed: AY fN�
End Cap _Y X
Inlet/Outlet Pipes&Baffles Y
Location/ Separations
Foundation to tank
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan _Y_ N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
5y5jem Use s•
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-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
a 9
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: pp
NAME: ^��"� PERMIT NO.: -4 l o
LOCATION: Ir% INSPECT ON: CJ
RECHECK:
Comments and/or diagram
Soil Type: Sand/
Tpe of Water: Municipal Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A _
<t'�
Absorption Field: Total length ft 'l�"
Length of each trench ft. � ��
Depth of trenches ft.
Size of Stone ('0/,-Z)o
Seepage Pits. Number L
Size: x
Stone Size:I—
Piping Size Type
Building to tank ��� 2L
Tank to Distribution Box A
Distribution Box to Field Pit 1
Opening Sealed: Y N t(�
End Cap N
Inlet/Outlet Pipes&Baffles
Location/ Separations
Foundation to tank
Foundation to absorption ft—
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built J Y N
Location of System on Property:
Front R a Left Side Right Side Middle Fron Middle Rear
5ystemUse S 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
Details ProOded by APPIAN Consulting Engineers — www.oppianengineers_com 12105/2005 — 10,a7:05 AM
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SEPTIC TANK NOTES
1. Access at or above grade level must be secured against unauthorized access.
2. Tank is not rated for vehicular traffic loading.
3. All resin used is compliant with ASTM D 1248 as required by CSA B66 and IAPM0 PS 1-2004e1.
4. Tank material of construction is HM'w'4,t-HDPE.
.5. Primary dimensions are in inches
6. Minimum tank wall thickness is 114".
7. Labeling will include: manufacturer name, liquid capacity, date, maximum burial depth, and model number.
8. Riser cover contains the following: W x 3" warning: :z
"Danger-Do not enter-Poison Gas" -written in English, French&Spanish.
9. Maximum burial depth from manufacturer is 36"unless specifically instructed otherwise by the factory. (A
10. Models ST 750,ST 1060, ST 1250 and ST-1500 are all certified to CSA and lAPM0 standards- NOTES
11. Models ST-500,ST-900 and ST-10UQE are compliant with CSA and IAPMO standards. T
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779i1[}9['ali,E 7 1 ,�"tEPTECH Tm TANK
V LOT WAM- 12 1000 GALLON l MODEL ST- I OOOE �[ieaerad�oaysDrne
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trees, fences,etc., ;.shown a�this document. t also represent
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