2011-150 TOWN OF QUEENSBURY
w 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110150 Date Issued: Thursday, May 05, 2011
This is to certify that work requested to be done as shown by Permit Number P20110150
has been completed.
Tax Map Number: 523400-296-009-0002-055-000-0000
Location: 13 OAKWOOD Dr
Owner: TERRY & SUSAN DE LONG
Applicant: TERRY & SUSAN DE LONG
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 r' =f
property owner of the responsibility for compliance with Site Plan, r. •,`
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
4411%)
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110150 Application Number: A20110150
Tax Map No: 523400-296-009-0002-055-000-0000
Permission is hereby granted to: TERRY&SUSAN DE LONG
For property located at 13 OAKWOOD Dr
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: TERRY&SUSAN DE LONG Septic Alteration Residential
13 OAKWOOD Dr Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
BP 2011-150
Septic Alteration-Residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 28,2012
(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 o ueen ury; Jhur. la `April 28,2011
de
SIGNED BYIV ` for the Town of Queensbury.
Director of Building&Code Enforcement
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TAX MA NO. PERMIT NO. - tut! .�,„_y:(ar-Y
TOWN Or- H
APPROVALS: ZONING TOW CLERRUILr `.: CODES
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. McAr- .A..5 5-fri-c )drIC.
OWNER: . .2-,-..w1_ t 5"..z., 0 aSL,_ INSTALLER: ./yyL...-.-ivj, x"7:4 5,- -:.
ADDRESS: /3 C 0.111.;.�rx-. D D . ADDRESS: /c7? (9,2„,,,..2j21 AvJ .,,,..„.. /fitr., r
PHONE NOS. 7 Y 5-Sd.9L PHONE NOS. 7c3 224(2: 7 L`y a"/.3 q -- C-
LOCATION OF INSTALLATION: 2i..cti._ 1 .3 L) -Aj`co eQ j/),rC----'
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older 3 X 150 = y -5-‘:+j INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING X STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? C -
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL L. WELL (If well:water supply from any septic system absorption is: ftI
✓ PERCOLATION TEST: RATE IS PER MINUTE PER INCH[mpi]
(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).
TANK SIZE: /.4,6L-y, 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:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length 2��
g ft. Each trench 2 X s=;)
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
0 ALTERNATIVE SYSTEM Bed or other type?
0 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 requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewage Disposa iinance. codes(cilqueensbury.net
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"-�i _����. VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.aueensbury.net
Town of Queensbury * Community Development Office * 742 Bay Road, Queensbury NY 12804
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Septic Inspection Report
Office No. (518)761-8256 Date Ins on requ .-'- :.:
Queensbury Building&Code Enforcement Arrive: �c a ►,/, 1 lP .,-part: _ Da am 4 411,
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials*ettla
NAME: 06-L.vAlNO.: l` '6
LOCATION: / ��KG(Jdt1/.1 SPECT ON: it
RECHECK:
Comments and/or diagram
Soil Tye.•..... I ,.e; i. .y
Type of Water u - •. /Well Water
Wate ne -partition distance 0 ft. F P_D tUT `I41R3Z?
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 V , ft.
Depth of trenches ft.
Size of Stone AZ
Seepage Pits: Number M..,
Size: ..�.-. .,x
Stone Size:
Piping , Size Type
Building to tank , 4" ,..6c,‘-‘ \C
Tank to Distribution Box 4" �
Distribution Box to Field/Pit '-1`` b'N- k' Q -
Opening Sealed: V .
'
N
End Cap .N
Inlet/Outlet Pipes&Baffles ,-0 ". -C %•°\2'-C %•°\2'Manholes 12"or less below grade ✓ N �
[provide extension collar iYes] N
Location/Separations
Foundation to tank ;.,ft. Tb 12 �V— .
Foundation to absorption L � c 6P—NV �--.
Separation of Pits ft.
Conforms as per Plot Plan VY 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
Approved
Partial Approved and needs to be re-Inspected,please call the Building&Codes Office
Disapproved
LAPam Whiting\2010\Bu11ding Codes Formsurupection Forms\Septic Inspection Report03 29 10.doc
A518-793-2290.
Fax#518-793-2115
N° 4 4 2 i E-mail:momingstarseptic@hotmail.com
www.momingstarseptic.corn
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I1 DECEDWE
APR 2 7 2011 E
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TO NOF QUEENSBUR yr�' TOWN OF QUEENSBU' Y
BUILDING DEPARTMENT �� BUILDING& CODES
Based on our limited examination,c mpliance
with our com nts shall not be co trued as
indicating th plans and specificati s are in
full complian with the Building odes of c
New York Ste e. i
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P • r N OF QUE SBURYBUILDING & CO �
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'��' ( Date: