2008-549 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CE RTIFICATE ("-)IF0 COMPLIANCE
Permit Number. P20080549 Date Issued: Thursday, August 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20080549
has been completed.
Tax Map Number. 523400-302-005-0001-076-000-0000
Location: 6 GREENWAY Cir
Owner. ANDREW & DIANA DEL DIN
Applicant: ANDREW & DIANA DEL DIN
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&CocYe Enfo ement
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: P20080549 Application Number. A20080549
Tax Map No: 523400-302-005-0001-076-000-0000
Permission is hereby granted to: ANDREW & DIANA DEL DIN
For property located at: 6 GREENWAY Cir
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: ANDREW & DIANA DEL DIN
6 GREENWAY Cir Septic Alteration Residential
QUEENSBURY, NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-549
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, October 21, 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 Pown Queensbur, Tuesday, October 21, 2008
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SIGNED BY "� r for the Town of Queensbury.
Director of Building&Code Enforcement
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��FFICE USE ONLY L
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TAX MAP NO. PERMIT NQ. PERMIT FEE_�i '
APPROVALS: ZONING '
TOWN CLERK ;
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT
A PERMIT MUST BE OBTAi ED BEF RE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. ^�
OWNER: INSTALLER;
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ADDRESS: �C 'r (,ADDRESS:� ,,.� r
PHONE NOS. PHONE NOS. C; J
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LOCATION OF INSTALLATION: Cx. P (.. C C, G d
NO.O - ..1.. ......................:.........-...-....................I RESIDENCE INFORMATION:
YEAR BUILT' B ROOMS_ X -COMPUTATION= -• 1 a -TOT L DAILY FLOW I
.................................I GARBAGE GRIN R
1980 or older .�.-. .X -.160•gallon per bedroom } _ v�.....- .. I INSTALLED?
-1981 -1991 , X 130 gallon per bedroom = i SPA OR HOT TU 0
-1992�present. _..............................._. X.. .....110 gallon per bedroom. ¢. INSTALLED? 10
- ...- ............- ...........•......................................................................................_............M......_.. ............I.......-....................,...._....-_.-...................J
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLA OLLING PE % L P�� STEEP SLOPE- S 0 E
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER' T WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
(IF WELL:WATER SUPPLY FROM ANY SEPT C-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.,
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✓ SEPTIC TANKeytel`,A�ALLON ( IN. SIZE IS 1,000 GAL.) TiLE FIELD: EACH TRENCH/�^T.
✓ TOTAL SYSTEM LgNGTH: SEEPAGE PiT(S): HOW MANY?
✓ SIZE OF EACH FT, X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH ANDIOR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF;TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY:-GAL.
GAL.
4 NOTE•-ALARM SYSTEM'AND ASSOCIATED ELECTRICAf.WORK MUST BE INSPECTEDMBY A TOWN �!
ti APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. !j
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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 761-8256 OR EMAIL
Queen ury a itary Sewage Disposal Ordinance. codesCaueensburv.net
VISIT OUR WESSITE FOR MORE INFORMATION
www.-Queen ,urv.net
Slgnature of Person Responsible Date
Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
C
Septic Inspection Report
Office No. (518) 761-8256 Dabe Ins 'on nest received: 1 fJ Z i�UPS
Queensbury Building&Code Enforcement Arrive:rQm/ pa'fit am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME:
PERMIT NO.: C�
LOCATION: i �cTe INSPECT ON: -2.
RECHECK:
Soil T Comment and/or diagram
-TA of Water: unit! I !!Water
Wateriine separation distance ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft,
Size of Stone
SeepaQe Pits: Number
Size: x
Stone Size:
Piping i Type
Building to tank L
Tank to Distribution Box
Distribution Box to Fie Pit 7•
Opening Sealed: Y N ai
End Ca
Inlet/Outlet Pipes&Baffles Y N
Location/Se rations `
Foundation to tank ft.
Foundation tDabsorption ft. �
Separation of Pits ,ft.
Conforms as per Plot Plan N ��� :�✓�j �l�i
Engineer Report and As-Built Y N
Location of Sj�ilMn Property:
Front Rear Left Side Right Side
Middle Front fiddle Rear
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Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection requ ei d:
Queensbury Building &Code Enforcement Arrive: 7_ Q a m e am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: E IT NO.: 091
LOCATION: �U C-�� Ew11;A C`U I SPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water i\
Waterline separation distance ft. v� tt
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + - Y N N/A ` 1
Absorption Field: Total length
Length of each trench ft, t1
Depth of trenches ft.
Size of Stone /f
Seepage Pits: Number ll,J
Size: x
Stone Size:
Piping Size Type 1 t5
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Ca _Y N
Inlet/Outlet Pipes &Baffles _Y_N
Location 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 Rear Left Side Righ ide Middle Front Middle Rear
s m Use
Approv
rtial Approved needs to be re-inspected, please call the Building &Codes Office
Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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