2007-550 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIF1CATE '%(..NYF COMPLIANCE
Permit Number. P20070550 Date Issued: Wednesday, September 05, 2007
This is to certify that work requested to be done as shown by Permit Number P20070550
has been completed.
Tax Map Number. 523400-295-015-0001-048-000-0000
Location: 22 MOORWOOD Dr
Owner. JOHN & CHRISTINE SULLIVAN III
Applicant: JOHN & CHRISTINE SULLIVAN III
This structure may be occupied as a:
Septic Alteration Residential
By Older 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 8c 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: P20070550 Application Number. A20070550
Tax Map No: 523400-295-015-0001-048-000-0000
Permission is hereby granted to: JOHN &CHRISTINE SULLIVAN III
For property located at: 22 MOORWOOD Dr
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 QueensburyZoning
Ordinance. TWe of Construction Value
Owner Address: JOHN& CHRISTINE SULLIVAN III Septic Alteration Residential
22 MOORWOOD Dr Total value
QUEENSBURY, NY 12804-0000
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2007-550
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,August 28, 2008
(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 wn of ensbury; / Tuesday,August 28,2007
SIGNED. Y for the Town of Queensbury.
Director of BuNling&6de Enforcement ...:,. .. _
......r...r....................r...r..r..r..r.......r.rr.ysrrr.r ----------
OFFICE r.rrr1
1 ��o ��� j�/ , OFFICE USE ONLY ����lf«� lama r/t 0 ± ,/// 0
0 TAX MAP NO. / �-�/� PERMIT NO.�PERMIT 0 t� ;
+ + + +
APPROVALS: ZONING TOWN CLERK
+ ,
1...... -------------------r-...rr..rrr.r.... .................r....
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMITi
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNE "/f' A/ �� INSTALLER:
J1ADDREc 4r/ �,90 11C �C�� ADDRESS: �/�t!» �ly/�..J;—
PHONE NOS. ` L 2 — 19 9 v PHONE NOS.—7 (LL
LOCATION OF INSTALLATION: 2�' ' !��'t W�"X r -
».....»......».»......................... ........... ......... . ��....-................... ....._,..........»..................................,........i.............._.........................................................i RESIDE EINFORMATtON.
.
NO.OF _ TOTAL DAILY FLOW
YEAR BUILT t X COMPUTATION=
BED OM I.......... a.................. .......................................{ INSTALLED?GARBAQGRINDER
-µ1980 or older.. �y..._..» X 160 gallon per bedroom,.., _ _. ,, . ......»....... .. `'
1981 -1991 X 130 gallon per bedroom : l SPA OR HOT TUB
....................».»..... .'. ........».....................................•.......... , ............. .........•..........................................................................-.........................
1
1992-present X 110 gallon per bedroom j i INSTALLED?
»...»»... .....................»». .-......»....................»».•... ..•.._�. .». ...,.... ...I........................ ........... - .............................�
PARCEL INFORMATION:
✓ TOPOGRAPHY: F OLLING.�STEEP SLOPE %SLOPE
✓ S IL NATURE: SAND LOAM C Y
OTHER
✓ GRQUNDWATER: AT WHAT DEPTH? BEDROCOMPERVIOUS 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.,
Xl Se
✓ SEPTIC 7ANK: /000 GALL (M4N. SIZff IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT($): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: #� /DEPTH OR THICKNESS-1—FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO.OF TAGS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY. GAL.
.w•xxxl.••WN•xxxxxxxx••xxxxxxtN•xxxxt•xxxxxfN•xxINN•4xt•t•.•x.NN•.•vtN•.VN•x.•1..•.•.•.•t•.•.•.NUN..NNN•.N•.•..x.N.:•xx.UN..•.•.•...N•.U•.N•..NNU•i•.NNNN•1..•.•x...........•1•.•.N...•..000NU•xxx..xx.•x.N•.•SUN•.NNN•..1•.•.•.N•.N•x.U•x.•.•xxxx.y
�N NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. i
1..,...t.txx....,.INN.........,..•,•..,N.....,....N................................N...,.....,...:.:...;..., ......................,..,,........,.......,...:..N.:.....,.....,...,.,.....,...,...,.,...,.,.:...,...:,:...:,,.,.:...,.:.,N...,...........,..•,...,...;.x.... x....x.N.xx»....,.xx�
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 78i-8256 t EMAIL
Queensbury S itary Sewage Disposal Ordinance. ggdes�aueensburvr,e
VISIT OUR WEBSITE FOR MORE INFORMATION
www:aueenaburv.net
Slgn ure of Person Responsible Date
Town of Queensbury • Community Development Office - 742 Bay Road, Queensbury, NY 12804
i
� ' Report Septic Inspection
Office o. (518) 761-8256 Date Inspection request received: - c - 7
Queensbury Building &Code Enforcement Arrive: am/pm epart: am/pm
742 Bay Rd., Queensbury, Y 12804 I)nspector's Initials: ' _ —S
NAME: PERMIT NO,:
LOCATION: r vL-� INSPECT ON: 1 I
RECHECK: ?�� 0
ommen an or dia r m
Soil Type: Loam/ Clay
Type of Water: Well Water
Waterline separation distance ft.
Well separation distance Vft.
Other wells: ft.
Well Casing Len t - Y N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches — ft.
Size of Stone
Seepage Pits: Number IV
Size:
Stone Size:
Piping Size Type
Building to tank '
Tank to Distribution Box
Distribution Box to Field/ Pit t`
Opening Sealed: N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Location Se arations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan N
Engineer Report and As-Built N
Location of System on Property:
Front ea Left Side Right Side Middle Front Middle Rear
S e e us:
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- D\Building&Codes\Inspection FvM\Septic Ind Reportdoc
o /
1
l
�b
pale VJ°0 �
� 2
Aj
o
9 9 9 9
v �
Jam.
(tir
1
TOWN OF QUEENSBURY
BUILDING & CO EPT.
Reviewed By:
Date; �"