2011-144 ..� _, 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: P20110144 Date Issued: Wednesday, December 19, 2012
This is to certify that work requested to be done as shown by Permit Number P20110144
has been completed.
Tax Map Number: 523400-301-005-0001-005-000-0000
Location: 777 WEST MT. Rd
Owner: ROBERT& PATRICIA DI STEFANO
Applicant: ROBERT& PATRICIA DI STEFANO
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 Lidding& ode orc nt
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
.41111 742 Bay Road,Qucensbury,NY 12804-5902 (518)761-8201
VTIO
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110144 Application Number: A20110144
Tax Map No: 523400-301-005-0001-005-000-0000
Permission is hereby granted to: ROBERT&PATRICIA DI STEFANO
For property located at 777 WEST MT. 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. Type of Construction Value
Owner Address: ROBERT&PATRICIA DI STEFAN( Septic Alteration Residential
777 WEST MOUNTAIN Rd Total Value
QUEENSBURY,NY 12804-8123
Contractor or Builder's Name/Address Electrical Inspection Agency
MORNING STAR SEPTIC
Plans&Specifications
2011-144
septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,April 25,2012
(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.)
a 1 .
Dated at the Town of Q ensb .44/Alida ,, a j' 25,2011
SIGNED BY Vel for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010
OFFIC S ONLY
.<_30‘,TAX MAP N 75----PERMIT NO. //'— / 4ERMIT FEE__
• APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT.
OWNER: 0 ,(1 cl INSTALLER: /2yy, Slc-►_ 5�..L4--
ADDRESS: 7 7 Z C:+.%. 4?- Zw ADDRESS: /6'7 /4 b
PHONE NOS. 74'' 2. 2.C., PHONE NOS. *)?3 2-.-2-C‘.0
LOCATION OF INSTALLATION: 744— is 7
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? _,-.---
1981 -1991 X 130 = SPA OR HOT TUB
1992-present 3 X 110 = .73c INSTALLED? .f--
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE i %SLOPE /dam}--10 i S
✓ SOIL NATURE: SAND 4 LOAM CLAY OTHER
I GROUNDWATER: AT WHAT DEPTH? .5'11L
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? '
I DOMESTIC WATER SUPLY: MUNICIPAL 7L WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS 2';c,' PER MIINUTE PER INCH(mpij
(Test to be completed by a licensed professional engineer or architect)
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).
/L
TANK SIZE: - 1 GALLON (MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE: kf/i'' '----/) 1/f.---)L i34/
o A SORPTION FIELD(WITH NO.2 STONE) Total length -ft. Each trench-�S*'' X—+-
SEEPAGE PIT(S)(WITH NO.3 STONE) How many? 2— Size? (c) X e
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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 requ ements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewage Disposal rdi ance. codesPqueensburv.net
inti w lJC-- +n VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Perso Responsible Date www.queensburv.net
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
) --2_, __ ( /7,4_,..
Septic Inspection Report / /
Office No. (518) 761-8256 Date Inspectio request received: L1/ 21
Queensbury Building & Code Enforcement Arrive: I:,,' J am/p• Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: . Cf
NAME: b e Cts ('SAN 0 PERMIT NO.::_� ` L 1 L 1
LOCATION: -77 -1 t-1(_sT M 7-, la-0 . INSPECT ON: iF 7
RECHECK:
Comments and/or diagram
Soil Types- ---. oam / Clay
Type of Water:A/Municipal ell Water
Wate .- .:-•;`ation distance /1.--ft.
-
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench _ft.
Depth of trenches ft.
Size of Stone
- i- Seepage Pits: Number
Size: c,. x
Stone Size: ; /�
Piping . Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit `' 47K'- -'
Opening Sealed: Y N
End Cap , N
Inlet/Outlet Pipes &Baffles N/ Y N
Location/ Separations
• Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as perP _i N
Engineer Report an As-Built \ "Y N
Locati• . • tern on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S -„ . s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
q.v./L.4eptic Inspection Report
Office No. (518) 761-8256 Date Inspectio request received: I
Queensbury Building &Code Enforcement Arrive: 2.Vo am/pmI ppepart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: cJf
NAME: b D PERMIT NO.: dol 1-'1 .
LOCATION: 1 )7 041-A-6/4-1,/ INSPECT ON: ' __ • l am'
RECHECK: 0
Comments and/or diagram
Soil Type: Sand / Loam/ Clay
Type of Water: Municipal / Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
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 Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: _Y— N
End Cap _Y_N
Inlet/Outlet Pipes &Baffles _Y N
Manholes 12"or less below grade __Y_ N
[provide extension collar if Yes] TY..T N
Location/ Separations
Foundation to tank ____ ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan T Y N
Engineer Report and As-Built _Y_ N
ETU Maintenance Contract Y_ N dor
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
proved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc
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BUILDING DEP RTMENtoPdliea:ceof
Based on our lishah hot be construed as
with our comments ands specifications ar �iin�, dip. ._ — —_-- ndicating the plans �uilding
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with t --___I BUILDING & CO FIE, It F cOP ew York State.
Reviewed ,1 ',„.
Date: _liiiI' .�_ ,