2008-661 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE (DYrc, COMPLIANCE
Permit Number. P20080661 Date Issued: Wednesday, September 08, 2010
This is to certify that work requested to be done as shown by Permit Number P20080661
has been completed.
Tax Map Number. 523400-239-015-0001-019-000-0000
Location: 2 HIGHVIEW Rd
Owner. MATTHEW EMMENS
Applicant: MATTHEW EMMENS
This structure maybe occupied as a:
Septic Alteration Residential
By Older of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (0�j)j W �ot
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: P20080661 Application Number. A20080661
Tax Map No: 523400-239-015-0001-019-000-0000
Permission is hereby granted to: MATTHEW EMMENS
For property located at: 2 HIGHVIEW 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: MATTHEW EMMENS
4080 HOWELL Rd Septic Alteration Residential
MALVERN, PA 19355-8697 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-661
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,December 19, 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 a the T of eet�sbu ay, December 19, 2008
SIGNED BY /���' for the Town of Queensbury.
Director of Building&Code Enforcement
'+-'--'+--- OFFICE USE ONLYr__-..-._�----------------%
TAX MAP N0. 'PERMIT NO PERMIT FEES_
APPROVALS: ZONING TOWN CLERK_ ;
____ ..._.._.-_.._.-_____-.
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMITS
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: Matthew Emmens INSTALLER: Creative Construction
ADDRESS: 4050 Howell Road, Malvern, PA ADDRESS: 248 Sly Pond Road, Fort Ann, NY 1282
-
--- 19355 _- -
PHONE NOS. PHONE NOS.
792-4213
LOvATION OF INSTALLATION: NYS ROute 9L, Queensbury, NY
..........................................................................
•• ................................................... RESIDENCE INFORMATION:
YEAR BUILT X I COMPUTATION= ; _ TOTAL DAILY FLOW i
.... ............BEDROOMS .......... .... I GARBAGE GRINDER
:.............................•.• ... .............•.<. ...................i........................................ ....�... ...1..........................................................................i
1980 or older I ; X 150 gallon per bedroom INSTALLED? No
:..............................,.................:..........................................................I...................................................................... ..... ...................................................................
3 1981 -1991 X ; 130 gallon per bedroom _ ? t SPA OR HOT TUB
................................................;..............................................t...........a......................................................................... ........... .......................................................................
..
i 1992-present i 5 1 X j 110 gallon per bedroom _ 550 INSTALLED?
i................................................:..........................................I,.....,.................................................................... .....i...........,.............,....,......................................................., O
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING X STEEP SLOPE %SLOPE 176
✓ SOIL NATURE: SAND LOAM CLAY OTHER Sandy Loam
✓ GROUNDWATER: AT WHAT DEPTH? 28" BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH? _1.52-44"
✓ DOMESTIC WATER SUPLY: MUNICIPAL_._ WELL X
(IF WELL: WATER SUPPLY FROM ANY SEP� IC-SYSTEM ABSORPTION IS 181 FT.-)
✓ PERCOLATION TEST: RATE IS 3m 30 sec PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESS1014AL ENGINEER OR ARCHITECT)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect (unless irstalled 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 TANK: 1500 GALLON (MIN. SIZI IS 1,000 GAL.) TILE FIELD: EACH TRENCH N/A FT.
✓ TOTAL SYSTEM LENGTH:
N/A FT. SEEPAGE PIT(S): HOW MANY? N/A
✓ SIZE OF EACH N/A FT. X N/A FT.
✓ SIZE OF STONE TO BE USED: # N/A/DEPTH OR THICKNESS NIA FT.
✓ BED SYSTEM SIZE: 6 X 52' x 3' = 936 SF
Laterals Long w-Iae
✓ ALTERNATIVE SYSTEM: N/A LENGTH ANDIOR SIZE NIA
✓ HOLDING TANK SYSTEM:(If required) NO. 01- TANKS: N/A, /SIZE OF EACH N/A
` i1 -PEI�-bAY^
-
- 1---GALLONS.rT Gil-Y., -55G--- G�_
.•..:...........................:...............:.:.....:.:........:........ ,......:...,...........:... .:..........,...,,............,....,,,,,.,.....,...,,:.,,,,,,,:,,.. .......................................
,.:,
NOTE: ALARM SYSTEM AND ASSOCIATED ELEC'+RICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
ii ,,,,.
............................... ..:......:.:i..........:.........,..,........... .... ......,... .... ...... .. ......,:..., ..,....,.,,...,..,,�..,.:,...
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 nqur . OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. cedes®aueensl�urv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburv.net
.101
// to a�
ignature of Person Responsible Date
Town 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/ Depart: )am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
e—
``
NAME: C-m!!L PERMIT NO.:
LOCATION: t,-' INSPECT ON:
RECHECK:
Comments ments and/or diagram`
Soil Type* Sand/ Loam Clay
Type of Water: Municipal Well Water /
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + /- Y N N/A
150'to well Tguired if NO11
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x �/ �
Stone Size:
Piping Size T
Buildingto tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade ___-Y^N
[provide extension collar if Yes Y N
Location Se rations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan 1Y N
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y _N
rovided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
stem se Sta _
Approv
i Approved and needs to be re-inspected, please call the Building&CAdes Office
Disapproved
L:\Pam Whiting\2010\13uilding Codes Forms\Inspection Forms\Sepbc Inspection Repork_03 2910.doc
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No......
�f..... �(„l.... �.. .1✓Uert. N2 10 218 Cut-in Card No.....................................
Owner..................... �)J�11i ✓
.....................................................................................................................
Location.................... Z.T.�L...................r�...............J...................................................�...EL�.../.............
Installation Consisting of... ....... ....... ............... ...........
....................................................................................................................................................................................
.....................................................................................................................................................................................
InstalledBy...... '.. /.r?r:.�4....!�.....................................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of maki pections at any time, and if its
rules are violated,the Company shall have the rigv
ke thi certi cat
L/ ..�
Date...jE�...t..y ll.................... INSPECTOR. ............ ..............................................................
Member N.F.P.A.,I.A.E.I.