2011-168 TOWN OF QUEENSBURY
742 Bay} R oad,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110168 Date Issued: Thursday, May 26, 2011
This is to certify that work requested to be done as shown by Permit Number P20110168
has been completed.
Tax Map Number: 523400-266-001-0002-060-000-0000
Location: 42 SUNSET Trl
Owner: THERESA A CASSELLA
Applicant: THERESA A CASSELLA
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 theavP /j5t--
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: P20110168 Application Number: A20110168
Tax Map No: 523400-266-001-0002-060-000-0000
Permission is hereby granted to: THERESA A CASSELLA
For property located at: 42 SUNSET Trl
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: THERESA A CASSELLA Septic Alteration Residential
42 SUNSET Trl Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2011-168
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday, May 06, 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.)
Dated at the Town of eensbu
Q� ty�.,r >�ridaygA��ay 06, 2011
/ � r1
SIGNED BY �' ` n / for the Town of Queensbury.
Director of Building&Code Enforcement
e s•�
Revised 4/14/2010
�T������ /PERMIT NO. PERMIT FEE T
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:k &(e&43 A- 0-A4'f'!r-4f-1tV INSTALLER:__ �p�0 cr'� 'S ('00 e/%
ADDRESS: 6UI`46--r ej-iZ ADDRESS:
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION: %/G�CG� ��GC� 14L.R65 tM*P
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDRO MS Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 = 47C41— INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLI G STEEP SLOPE %SLOPE
✓ SOIL NATURE:
QQ SAND LOAM CLAY OTHER
✓ GROUNDWATE AT WHE EDT PTH?
✓ BEDROCKIIMPERVIOUS MATERIAL: AT WHAT DEPTH? I f �(T5� A
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL 4 (If well:water supply from any septic system absorption is: ft) Y /N
✓ PERCOLATION TEST: RATE IS ► PER MINUTE PER INCH[mpi]
(Test to be completed 5y 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).
Ec/S7/NCSt
TANK SIZE: 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 TY : =j!q L r,,AA mr s
LWABSORPTION FIELD ) Total length a -0t. Each trench X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑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 reg ation with respect to this application and agree
to abide by the d a ements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Se Dis s rdinance. codesCaDaueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Signat re f Person Responsible Date www.pueensbury.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
Septic Inspection Report
Office No. (518)761-8256 Date Inspects n request received:
Queensbury Building&Code Enforcement Arrive: an/ Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's I ditials:
NAME: PERMIT NO.: J
LOCATION: > INSPECT ON:
RECHECK: r�l
Comments and/or diagram
Soil Type: San /
Type of Water: Munici Well Wat
Waterline separatio—n-d-is7lince 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
Depth of trenches ft.
Size of Stone 0
Seepage Pits: Number
Size-: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: N
End Ca _ N
Inle Outlet Pipes&Baffles IV
Manholes 12"'or less below grade N
[provide extension collar if Yesl N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.—
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built _Y N
ETU Maintenance Contract Y_N
provided
Location of System on Property:
Front_. Rear Left Side Right Side Middle Front Middle Rear
System Use Status•
Approved
Partial Approved and needs to be re-Inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Fomns\Septic Inspection Report-03 2910.doc
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