2005-799 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: P20050799 Date Issued: Friday, October 07, 2005
This is to certify that work requested to be done as shown by Permit Number P20050799
has been completed.
Tax Map Number: 523400-309-013-0001-017-000-0000
Location: 33 OHIO Ave
Owner: MIGUEL & JENNIFER SANTIAGO JR
Applicant: MIGUEL & JENNIFER SANTIAGO JR
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: P20050799 Application Number: A20050799
Tax Map No: 523400-309-013-0001-017-000-0000
Permission is hereby granted to: MICTT JEJ,& TF.NNTFF.R S ANTI AGO TR
For property located at: 33 OHIO Ave
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: MIGUEL& JENNIFER SANTIAGO .
33 OHIO Ave Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
i
Contractor or Builder's Name / Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OI TEENSBI TRY_ NY
Plans&Specifications
2005-799
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, October 07, 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 th To Qu Ory; iga—y, October 07, 2005
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit- Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
e-_- I n-
1. OWNER INFORMATION: OrA41 � ............ ...... .........................
Office Use
LL
Location of installation:
File Permit No. lrns-
Tax Map No.
Fee Paid
Owner's Name:
-jt-3 2(1115
Address:
2. INSTALLER'S NAME -T 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 Ho A�1'1 ? No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm =
1980- 1991 x 130 gal/bdrm =
1991 -present x 110 gal/bdrm. =
Garbage Grinder Installed yes no
Spa or Hot Tub Installed yes no
4. PARCEL INFORMATION: (circle applicable information& indicate measurements)
-n Too grapliv So' ature Ground Water Bedrock or Impervious Material ter Su lv
/71 la L) sand at what depth at w at epth municipal
m
oilling m _"feet eet we
Steep slope clay if well; water supply>
Yo slope other from any septic-system
depth: absorption is
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 Tank: 11900 gallon (min. size 1,000 gal.
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: S� X
-
Alternative System: EAJ'r-c4e A./ length andlor 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 knowri, 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.
Z& C
responsible person Date
Signature of res nsible person
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
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Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
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Septic Inspection Report
Office No.(518)761-8256 Date Inspection re uest r ive
Queensbury Building&Code Enforcement Arrive: am/p D 'art:
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi 1
NAME: l (J S �i t L P IT NO.: 7—
LOCATION: ,- � _ ECT ON: / 7 4
RECHECK:
Comments and/or diagram
Soil T : �'San
Type of unici Water i - 1_ 0
Waterline sea istance ft.
Well separation distance
Other wells: ft. ��_ ;� ,c., 1;
Absorption Field: Total length ft.
Length of each trench
Depth of trenches — °-
Size of Stone
Seepage Pits: Number -� -
Size: x
Stone Size: ,
I
f
Piping Size Type l /
Building to tank 't
Tank to Distribution Box +�
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
End Caps
Location/Separations
Foundation to tank ft.
Foundation to absorption 77 ft.
Separation of Pits ft.
Conforms as per Plot Plan V Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Fr Middle Rear
S stem Use Sta s:
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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