2011-540 eaki TOWN OFQ UEENSBURY
Bay Road,
742 Queensbury,Quee NY 12804-5902 (518)761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110540 Date Issued: Monday, November 07, 2011
This is to certify that work requested to be done as shown by Permit Number P20110540
has been completed.
Tax Map Number: 523400-301-007-0001-049-000-0000
Location: 24 BUENA VISTA Ave
Owner: PATRICIA FRAZIER LIFE USE
Applicant: PATRICIA FRAZIER LIFE USE
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 raNpd
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
F 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
SI
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110540 Application Number: A20110540
Tax Map No: 523400-301-007-0001-049-000-0000
Permission is hereby granted to: PATRICIA FRAZIER LIFE USE
For property located at: 24 BUENA VISTA 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: PATRICIA FRAZIER LIFE USE
MAUREEN FRAZIER Septic Alteration Residential
24 BUENA VISTA Ave Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2011-540
septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,October 31,2012
(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 th(`awagf Qu: i sb ry; / i ' onday,October 31,2011
SIGNED BY ) for the Town of Queensbury.
Director of Building&Code Enforcement
``. Community Development Office
Town of Queensbury ® 742 Bay Road a Queensbury, New York =12844
Office Use Only
--, (ll / 7L__ 1-/17
TAX MAP NO. ' ' PERMIT NO. / PERMIT FEES`-
APPROVALS: ZONING TOWN CLER
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW 5EFORE ISSU E OF A ID PERMIT.
OWNER: 1--)141-1(t Ci Fi211-24 g,x_, INSTALLER: j All/ irlbl jGu,'4,r eQZuj e
ADDRESS:2-11 .13 tr # VI J r A ADDRESS: e b -3 ( 22 Y
. ! 6 F
PHONE NOS. 7 ct a - I/I C PHONE NOS. 7 [Qc " d ���
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT
NO. X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRIN
1980 or older 3 X 150 = Y‘°
INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB pp
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
I TOPOGRAPHY: FLAT ROL9J STEEP SLOPE %SLOPE
I SOIL NATURE: SAND ;// LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
I BEDROCK/IMPERVIOUS MATERIAL: ATWHAPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL�' WELL (If well:water supply from any septic system absorption is: ftl
✓ PERCOLATION TEST: RATE IS PER MIINUTE 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: 10 b) 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: 2 0 0 ,A / 5-0 '
ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. 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 •: e re-e-+4=r;'ulations with/- pect to this application and agree to
_a •e b th:-: rt: requ" - is of the Town of ueen ury QUESTIONS? CALL 761-8256 OR EMAIL
i - Se Ar�Tf' a •posal o poi ance. codes(ci?aueensburv.net
Jnirlrl�at �I r VISIT OUR WEBSITE FOR MORE INFORMATION
Si: ature of - rson Responsible ate www.queensbury.net
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Septic Inspection Report
Office No. (518) 761-8256 Date I • iv=-: _
Queensbury Building&Code Enforcement Arrive\: ,.. . -.. : am
742 Bay Rd., Queensbury, NY 12804 Inspector's In •
NAME: (ll L/ n " PERMIT NO.: ]j/ V
LOCATION: 71r ��r�.-ems ci ( — ,1 -
i/i`5� SPECT ON: ,�
RECHECK:
Comments and/or diagram
Soil Type:, . • 'P .:m/Clay
Type of Wa - • um..•: ell Water
Wa . •akr-•- ••• •istance ft.
r
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 t
Depth of trenches °z_-- ft.
Size of Stone .d y
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank U
Tank to Distribution Box 111j�i2 7j (' �_ pew^
Distribution Box to Field/ Pit
Opening Sealed: ✓Y N
End Cap N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade 4,Y N
[provide extension collar if Yes] Y—N
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits / ft.
Conforms as per Plot Plan Y
Engineer Report and As-Built Y N
ETU Maintenance Contract Y_ N
provided
Location of System on Property:
Front ik-•21,2 Left Side light Middle Front Middle Rear'
stem . .•
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
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1 SIGNATURE _ -
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TOWN OP OUEENSBURY ,
BUILDING DEPARTMENT
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Based on our limited examination,compliadnce 12\
with our comments shall not be construeas
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State.
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TOWN OF QUEENSBURY_ II
BUILDING & CODES DEP . ,---......) I
Reviewed :y: qi
Date: Millik
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