2005-210 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
42 Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050210 Date Issued: Friday, April 15, 2005
This is to certify that work requested to be done as shown by Permit Number P20050210
has been completed.
Tax Map Number: 523400-295-010-0001-057-000-0000
Location: 2 BONNER Dr
Owner: THOMAS & GLENDA ROGERS
Applicant: THOMAS & GLENDA ROGERS
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&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: P20050210 Application Number: A20050210
Tax Map No: 523400-295-010-0001-057-000-0000
Permission is hereby granted to: THOMAS & GLENDA ROCTF,RS
For property located at: 2 BONNER 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 Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: THOMAS & GLENDA ROGERS
2 BONNER Dr Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name / Address Electrical Inspection Agency
Plans&Specifications
2005-210
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, April 15, 2006
(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 T f 1 , A ril 15, 2005
n o ueens
SIGNED BY for the Town of Queensbury.
r .Y
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: ............................................................................................................................;
Office Use
Location of installation: M C
File Permit No. on. v
Tax Map No.
D M Fee Paid �'
Owner's Name:
:........................................................................................... ......................,..
Address: (�/V H C
2. INSTALLER'S NAME 1 c r J / PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No of Bedrooms x Computation = Total Daily Flow
1980 or older _ x 150 gal/bdrm = �d
1980—1991 x 130 gaVbdrm =
1991 —present x 110 gaVb&m = KECE I V E d
Garbage Grinder Installed yes, / no
Spa or Hot Tub Installed yes_ / nol-ir rR `( 5 2005
OF
4. PARCEL INFORMATION: (circle applicable information&indicate measurements) TOWN BUILDING AND CODE QUEENSBURY
TogberaDhv SagZ71ature Ground Water Bedrock or Im ervious Material ter Supply
F at sand X
depth at w epth municipa
ling feet feet
Steep slope clay if well;water supply
�%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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.
, c
Septic Tank: Pr(Xgl llon (min. size 1,000 gal)
- 1. --
Tile Field: each trench ft. Total System Length:
Seepage Pit(s): number of size of each: ft by ft
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: ! Size of each: gallons /TOTAL Capacity: gallons
i
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7. SICGNATUItE &INFORMATION FOX YON.'iWi..tr ......:;
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b m
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C.)
AY
REVIEW D IY y
,� DATE
Septic Inspection Report
Office No.(518)761-8256 Date Inspection request received: / G5
Queensbury Building&Code Enforcement Arrive: am/ ep
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: �
r lj.�r.Jam- l
NAME: ---,/p r-. 0 rs PERMIT NO.:
LOCATION: INSPECT ON:
RECHEC
Comments and/or di ram
Soil T : Sad Lo !Clay
Type of r: unic' al/Well Water
Waterline separAtioVistance 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
Seepage Pits: Number
Size: x
Stone Size:
Piping S' e Typ
Building to tank
Tank to
Distribution Box to+iet&/Pit
Opening Sealed: Y/N/Partial
End Caps
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 Rear Left Side Right Side
Middl Front Mid le Rear
System Use Status
•
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 1/6/05