2004-127 1
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: P20040127 Date Issued: Thursday, Apri108, 2004
This is to certify that work requested to be done as shown by Permit Number P20040127
has been completed.._
Tax Map Number: 523400-302-018-0003-005-000-0000
Location: 4 SPRUCE Ct
Owner: ARTHUR&BARBARA DE AVILA
Applicant: . ARTHUR&BARBARA DE AVILA
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Commercial TOWN OF QUEENSBURY
D
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040127 Application Number: A20040127
Tax Map No: 523400-302-018-0003-005-000-0000
Permission is hereby granted to: ARTM JR &BARBARA DE AVTLA
For property located at: 4 SPRUCE Ct
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: ARTHUR&BARBARA DE AVILA
4 SPRUCE Ct Septic Alteration Commercial
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2004-127
SEPTIC ALTERATION
$35.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,March 30, 2005
(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 Queen ury• ay, March 30, 2004
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
me.µ. T
Application for permit,Septic DI '0381 System
Town Of Queensbury 742 Bay-toad Queensbury,NY 12804 "(516) 761-8256
1. OWNER INFORMATION: r _
Location of installation: foku Gei 4 Office Use --
File P 4 7
��
Tax Map No. / , MA I� ^)' "
Owner's Name: 4714 -cf�� ;U %T"t/1 �'/
NN0/1
Address: c!CG C1 BUILD 11V ��COpF Y __..,..
2. IIISTAI,LER'S NAME - T'% (�Q,d(,iJ/G a P73ONE NO. .�9?_7 7
3. RESIDENCE 1NFORMAT�ON: (circle year of dwelling,indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal•total daily flow)
Yea%of House: No of Bedroom.s x Corapz_ation — Total Daily Flow
1980 or older x 150 gal/Ibdrm =
1980— 1991 x. 130 gal/bdrrn -
1991 —present x 110 gal/bdrtn —
Garbage CkInder Installed yes / no
Spa or Plot Tub Installed yes` / no e/
4. PARCEL YNFORMATION: (circle applicable information&indicate measurements)
1092aaRhy URNatured ock o
r Impervious AQM2292Waer Supply
at sand at what depth at what depth muntei a
g, feet _ et 1
Steep slope Clay `ewell;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
S. PROPOSED SYSTEM; For New Construction: All individual sewage disposal systexus 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: gallon(min. size 1,000 gal)
'I le Field: each trench ft. Total Systcm Lengdl d200
Seepage Pit(s): number of L/ sixe of each: ft, by ft.
Size%of Stone.to be.used: # / depth or thicA:ness 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. SIGNATtIRE &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 regulatio a cot to this application and agree to abide by these and all
re is of the Towne lie ti Sanitary ewage Disposal Qrdinnn e.
S gnature of resp to pe son ate
T00/T00 wd CC:CT MIL COOZ/TO/LO
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p epart: i pm
742 Bay Rd., Queensbuiy,NY 12804 Inspector's Initials: ��-
1
C- `
NAME: , j ` PERMIT NO.: � Lf
P��r l
LOCATION: u(� �, '�+c�tir, INSPECT ON: l— ::7 9 0 V
RECHECK:
r
Comments and/or diagram
Soil T e: San oam/ la
Type of Wa er: unite 1/Well Water
Waterline separate istance ft.
Well separation distance ft.
Other wells: ft.
Abso tion Field: Total length ft.
Length of each trench ft.
Depth of trenches Z ft.
Size of Stone L� O
-Seepage Pits: Number
Size: x
Stone Size:
Piping Siz Type
Building to tank G
Tank to Distribution Box
Distribution Box t ield/Pit `
.-Opening Sealed: )NI Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle oonnt Middle Rear
S stem Use Sta des:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
LASueHemingwayU3uieding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
7
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also rc' r-sent that' I have
�rsonally3,1ed/,,p- distar set forth on t, e diagra "
SIGN TURF DATE
-RECEIVED
MAR ?:& 2004
TOWN OF QUEENSBURY
BUILDING AND CODE
10 �
TOWN OF OUEENPPOUIRY
BUILDING C Sea
REVIEWED BYE. o
DATE
p��ue