2008-651 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE (11'E7 COMPLIANCE
Permit Number. P20080651 Date Issued: Thursday, August 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20080651
has been completed.
Tax Map Number. 523400-301-007-0001-034-000-0000
Location: 11 SYLVAN Ave
Owner: CHRISTOPHER & JODY MARTINO
Applicant: CHRISTOPHER & JODY MARTINO
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&Cod o ent
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: P20080651 Application Number. A20080651
Tax Map No: 523400-301-007-0001-034-000-0000
Permission is hereby granted to: CHRISTOPHER&JODY MARTINO
For property located at: 11 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: CHRISTOPHER &JODY MARTIN
11 SYLVAN Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-651
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,December 11, 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 te.)
Dated at the own o e Aur-s--day,December 11, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY ;
TAX MAP NO. PERMIT NO. (, PERMIT FEE �` J
00 APPROVALS: ZONING TOWN CLERK _ tl
o
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. / 4 11� I,
OWNER: / �VL7 INSTALLER: 'o �``
ADDRESS: t/4�A CL LrC ADDRESS: �� ✓� �'�z'� h'f Y
PHONE NOS. 2 PHONE NOS.
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
BEQ OMS Ile
1980 or older X 150 gallon per bedroom GARBAGE GRIN
9 P (1 INSTALLED
1981 -1991 X 130 gallon per bedroom =
SPA OR HOT TU
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling ° SI O a o /g Steep slope /a ope
✓ SOIL NATURE: Sand_` —Loam Clay Other
✓ GROUNDWATER: At what depth?
i
✓ BEDROCUMPERVIOUS MATERIAL: At 'hat depth?
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is x/Aminutes per inch [MPI]
(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 1,0() GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder, spa of whirlpool tub.
SYSTEM TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total length . Each trench � _X
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? �JJ&—ef: Size?
❑ ALTERNATIVE SYSTEM Bed or other type? '4 1L��
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? S 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 ofCwww.gueensbury.net
S? CALL 761-8256 OR EMAIL
Queensbury nitary Sewage Disposal Ordina Ce. des�aueensbury.net
BSITE FOR MORE INFORMATION
Qvi ature of Person Response le Date
�- Town of Queensbury - Cotnrnunity Development Office ■ 742 Bay Road, Queensbury, NY 12804
B 5-LGL
Septic Inspection Repoli
Office No. (518) 761-8256 Date Inspection quest received
Queensbury Building &Code Enforcement Arrive: I Y l a pm - fie art. 'Yc` arrj/p _
742 Bay Rd., Queensbury, NY 12804 Inspectors InitialsT
f
NAME: r PERMIT NO.:
LOCATION: INSPECT ON: - -
RECHECK:
Comments and/or diagram
Soil Typ#Ua oam / Clay
Type of water: Munici I Well Water
Waterline separation distance
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + J - Y N_N/A
Absorption Field: Total length
Length of each trench
Depth of trenches - ft.
Size of Stone ..
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank P::�->u 4-j-,
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: N
End Cap _" N
Inlet/Outlet Pipes &Baffles Y N
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 Y N
Location of System on Property:
Front IRear. Left Side fight Side Middle Fronts Middle Rear
5ystgm s-
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-01-13\13uilding&Codes\Inspection Forms\Septic Inspection Report.doc
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