2008-477 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTI F I CAT E 0--W COM P L I AN CE
Permit Number. P20080477 Date Issued: Thursday, August 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20080477
has been completed.
Tax Map Number. 523400-301-007-0002-033-000-0000
Location: 4 SYLVAN Ave
Owner. BRUCE &NANCY IMRIE
Applicant: BRUCE & NANCY IMRIE
This structure may be occupied as a:
Septic Alteration Residential
By Omer 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: P20080477 Application Number. A20080477
Tax Map No: 523400-301-007-0002-033-000-0000
Permission is hereby granted to: BRUCE &NANCY IMRIE
For property located at: 4 SYLVAN Ave
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: BRUCE &NANCY IMRIE
4 SYLVAN Ave Septic Alteration Residential
QUEENSBURY, NY 12804 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2008-477
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, September 04, 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 th �T rsday, September 04, 2008
SIGNED By 7 for the Town of Queensbury.
Director of Building&Co e Enforcement
Few 0 1 Ale 01 1 a,.I&....0,000.... ....r.r I I....I.................
[-T -� OFFICE USE ONLY
7
o TAX MAP NO. PERMIT NO. ERMIT FEE
i�
APPROVALS: ZONING TOWN CLERK '�
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.
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OWNER: ®' r (A C-C'.. - � r I -e INSTALLER:J _�. z c.t"' (a��,�►�J
ADDRESS:4 ) 1//_. uL~-�� ADDRESS: a- l �>�'
PHONE NOS. ! PHONE NOS.
LOCATION OF INSTALLATION: "�--�' LfGv
».» NO.Ot`».•...•....1...... ». ..-4-.....•..•....................... :•..................:...............
RESIDENCE INFORMATION,
YEAR BUILT BEDROOMS -X COMPUTATION= ; a »TOTAL DAILY FLOW ;
„, ..•............................I GARBAGE GRINDER
»»1980 or older» »»» »»»»»»» X »1.50,gallon per bedroom x• - ....�sv j INSTALLED?
» ..,... ......I ..I... ...... ...... ».... .......... 1
1981 -1991 X 130 gallon per bedroom s I SPA OR HOT TUB
{»................. p»-.............».•.....................•......................................................».............».........................................r.........................................................
...................;
t...•..1992»......resent..._...•..............................•...........f..»X..........»110 gallon per bedroom ..... _..............,»....».........,,..........._•.....rr.................•...»� INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING X STEEP SLOPE %SLOPE
SOIL NATURE: SAND LOAM CLAY OTHER
✓ RRQUNDWATER 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 siz"the septic tank and leach field for each garbage grinder, spa or whirlpool tub..
✓ EPT C TANK:4_�_-_GALLON (MIN.SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT, X FT.
✓ SIZE OF SaTONE TO BE USED:# /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: /c) -X O
✓ ALTERNATIVE SYSTEM:_ l.T�? LENGTH AND/OR SIZE /G — Se)
✓ HOLDING TANK SYSTEM:(if required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS.!TOTAL CAPACITY. GAL.
Il.l'3NOTE:1.,.,.1.1.,.1...............
.NN,.N,.,.,.,,.{•,.{.,.,.l.{.,.i.,.i.1•{.1.1•,.,•1.1.1.i.i.,.l.,.,.l.l.,.ul•l.t.l.l.,.l.l.l. ..,......,
ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN Il
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
•4l4.i.44{.N!•34r{.IrlrNl'1•Nl•4NNt•,•N •4f•NNI.l•1.Nl.i•4{•1•1•t•V{•i•{•t•i•41.t•4t.i•,•1......1...i•3.{•ir{•;.i.:•i•1.1K•:ti•N:•i•:•3•!•i•!4•N:r4,•1•N{•1•{.1.:•Y{.1.i•41•:•4NN3.1.1•I4.1.1.1•I•I.Yi•44441•i•N:•3•:•1.1•,•i•4{•3•WV.N4,.4N1•1.1N4.1•VI•I.4NV1.t•NNI.NI`I`IN.Ni•Ni
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
(allure 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 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. goclesQaueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
3, www.aueangurv.net
i-lgnaturis,dPeison Responsible Date
Town of Queensbury - Community Development Office 742 Bay Road, Queensbury, NY 12804
0
F. It I
Septic Inspection Report
Office No. (518) 761-8256 Date In=ction u cQueensbury Building &Code Enforcement Arrive: m e W. :aS��
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial
NAME: NO.:
LOCATION: ��fl _�-PAQ E— I PECT ON: 4%—tA
RECHECK:
Comments and/or diagram
Soil Type: nd am Cla
Type of Water: unl i e I Water
Waterl ration 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
Depth of trenches 22 ft.
Size of Stone E��� E-�
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box 9
Distribution Box to Field Pit x Opening Sealed: Y N C)
End Ca _ N
Inlet/Outlet Pipes&Baffles ZY N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits z ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rea Left Side Right Side Middle Fron Middle Rear
st m Use
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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