2005-515 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
4E Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050515 Date Issued: Monday, July 11, 2005
This is to certify that work requested to be done as shown by Permit Number P20050515
has been completed.
Tax Map Number: 523400-308-015-0001-034-000-0000
Location: 462 CORINTH Rd
Owner: PAUL & DOROTHY BAIRD
Applicant: PAUL & DOROTHY BAIRD
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 En cem
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: P20050515 Application Number: A20050515
Tax Map No: 523400-308-015-0001-034-000-0000
Permission is hereby granted to: PAT Tl,&DOROT14Y BAIRD
For property located at: 462 CORINTH 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. Tyne of Construction Value
Owner Address: PAUL & DOROTHY BAIRD
462 CORINTH Rd Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
FRED SMITH
23 VERMONT Ave
OI TEENSBI TRY_ NY 12804
Plans&Specifications
2005-515
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, July 11, 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 t D of Qu nsbury; Monday, July 11, 2005
SIGNED B for the Town of Queensbury.
Director of Buil ing& de Enforcement
Air X 1 IC, ro
Application for Pcrmit—Septic Disposal System
Town of Queensbuly 742 Bay Road Queen sbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: n , ` ,�
.............................................................................................. .. ......�..
Location of installation: 4�.-) 6)rlw 4// /ICY Office User-1
File Permit No.
Tax Map No. / p / r
Owner's Name:'/6)� rf R/4'd
VF
...
.................................................................. ......._...........................................
Address:. t L'► /Pd Jul- 8 2005
2. INSTALLERS NAME : A rid S�) W,/93��
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate ff bedroom(s) and multiply N of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year-of House: No. of Bedrooms x Computation = Total Daily Flow
11
/mod
1980 or older x 150 gaUbdnn = l tJ
1980— 1991 x 130 gal/bdrm =
1991 —present x,/110 gal/bdrm =
Garbage Grinder Installed yes` / no `Af
Spa or Whirlpool Installed yes ! no
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
tcranity_ !J(9 G.couttd_V�atvr _8951.rock_gr�tnporY�¢l!S ttt4ri,�l Don _itw5twply
l at who!(h pth al what depth ruurlcl
Rolling loam feet fe et Fwell
Steep slope clay if ivell; water supply
slope other from any septic-system
depth: absorption is fl.
other
Percolation Test: (To be completed by licensed prt fessional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by n licensed
professional engineer or architect(unless installed in a Planning 13oard approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlix)ol Tub.
Septic Tank: - gallon (min. size 1,000 gal.)
e
Tile Field: each trench S fT. Total System Length: L. fl.
Seepage Pit(s): number of size of each: fl. by fl.
Size of Stone to be used: ll / depth or
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 tale Town
of Queensbury, any pormit or approval granted which is based upon or is granted in
roliance 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 those and all
requirements of the t Queei bury Sanitary Sewage Disposal Ordinance.
Signature of responsible person D to
0
Septic Inspection Report
Office No.(518)761-8256 Date Inspection requ st received:
Queensbury Building&Code Enforcement Arrive: a D art: am/pm
742 Bay Rd.,Q nsbury,NY 12804 Inspector's Initial
NAME: PERMIT NO.: 00 5� S/s
LOCATION: INSPECT ON:
RECHECK:
_Comments and/or diagram
Soil T SandKoanjNClay
Type of unicip /Well Water
Waterline sea tion distfince ft.
Well separation i ance 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 Sizr t Type.
Building to tank
Tank to Distrib ox IL
Distribution Bo o.. A
Opening Seal Y /Partial
End Caps
Location/Separations
Foundation to tank ft.
Foundation to abso tion ft.
Se aration of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of Syst n Property:
Front ear Left Side Right Side
Middle Front Middle Rear
System Use Stat s:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
REt_gD .
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.Jul_ s; � 2005 �P/rJ�=-
TO ' � ` " c DAY TOWN OF OUEENSBURY
BUILDING & COD PT•
REVIEWED BY
DATE
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