2005-424 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050424 Date Issued: Wednesday, June 15, 2005
This is to certify that work requested to be done as shown by Permit Number P20050424
has been completed.
Tax Map Number: 523400-308-006-0001-038-000-0000
Location: 11 AMY Ln
Owner: THOMAS & SHARON OLIVIERI
Applicant: THOMAS & SHARON OLIVIERI
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: P20050424 Application Number: A20050424
Tax Map No: 523400-308-006-0001-038-000-0000
Permission is hereby granted to: THOMAS & SHARON nT,MERT
For property located at: 11 AMY Ln
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 & SHARON OLIVIERI
11 AMY Ln Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
OIJEENSBITRY SEWER
JAY SWEET
Plans&Specifications
2005-424
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, June 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 r:2�:p
bupy; d day, June 15, 2005
SIGNED BY wf for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,MY 12804 (518) 761-8256
i. OWNER INFORMATION: .............................. ......................................................... ...........
Office Use
Location of installation:
File Permit No. —rC7-
Tax Map No.
Fee Paid
Owner's Name: 0 Li tj j eicr
...........I................... .....................
Address: tQj
2. INSTALLER'S NAME to.4 fi,5c PHONE NO.
3. RESIDENCE INFORMATION: (circle year of delling, 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
80 or older x 150 gallbdrm. =
1 x 130 gal/bdrrn =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes_
Spa or Hot Tub Installed yes_ /<M) RECEIVED
J�N 1 3 2005
4. PARCEL INFORMATION: (circle applicable information&indicate measurements
TOWN OF QUEENSBURY
Topography Soil Nature Ground Water Bedrock or Impervious MateiWN1N06ffiFAi9WatCr SURPly
/-�j . <9tt� at what depth at what depth municipal
'ftlfzng loam feet —feet e
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption isl
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.
Septic f tanl 1,&&r2 gal�-* on (min. size 1,000 gal.)
-
Tile Field: each AcJ#4-$"4 ft. Total System Length:
Seepage Pit(s): number of size of each: _ft. by_j?.
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
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 Queensbury Sanitary Sewage Disposal Ordinance.
Signat4e o rebponsible person Date
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7• SIGNATURE &INFORIviATI� FoI, ruN;swL,.rzx%n*wL ►-o-.r.,....,
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SepticP p Inspection Report lol,)
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/_pepart: - Pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:�l
NAME: L rY �1` i P4/� PERMIT NO.:
LOCATIO k��,�_ INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: San Clay
Type of Water: PunicipA/Well Water
Waterlines aration istance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench $.
Depth of trenches tr&rO $.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping S' e T e
Building to tank / Icy ,J
Tank to Distribution Box -57 A �-
Distribution Box to Field/Pit_ K. A
Opening Sealed: Y/N/Partial
End Cap*
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
En 'neer Report and As-Built Y N
Locatio System on Property:
F nt Rear Left Side Right Side
Middle Front Middle Rear
System Use Statu .
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
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PP-VIEWED BY
REdE
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JUN 1 3 2005
TOWN OF: QUEENSSURY
ZONING OFFICE
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TOWN OF QUEENSBURY BUILDING DEPARTMENT
Based on our limited examination,
comppliance with our comments shall
not be construed as indicating the
plans and specifications are in full
compliance with the Building Codes
of New York Mate:
°aielS WoA MEN ao
sapo� 6ulpilnS a4i qtlm aouelldwoo
llna al eje suop:)g eds pue sueld
ayj 6ugeolpuw se panilsuoo aq jou
Mesas sauawwco:no Lg!m eoueydwoo
uopulwexa pa4pll Apo uo paseg
1N3N1L'`OO MOMS OSSN331`10 3O NMO1
"1u seen or observed, or believe I saw evidence of,
'f ;s evts such as houses, wells, trees, fences, etc.,
: �1nvri on this document. I also represent that I have
atonally measured the distances set forth on the diagram."
SIGMA URE DATE
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