2011-589 TOWN OFQ UEENSBURY
Iwo742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110589 Date Issued: Wednesday, December 07, 2011
This is to certify that work requested to be done as shown by Permit Number P20110589
has been completed.
Tax Map Number: 523400-308-011-0001-077-000-0000
Location: 75 SANDERS Rd
Owner: LORRIE CORKERN
Applicant: LORRIE CORKERN
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 ,,vfir6/X----/ /
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.
1
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110589 Application Number: A20110589
Tax Map No: 523400-308-011-0001-077-000-0000
Permission is hereby granted to: LORRIE CORKERN
For property located at: 75 SANDERS 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: LORRIE CORKERN Septic Alteration Residential
75 SANDERS Rd
Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
BRADLEY'S SEPTIC SERVICE
654-6318
47 HACK Rd
CORINTH NY 12822-0000
Plans&Specifications
2011-589
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,December 05,2012
(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 T n o ueens �hry;s f { o, ay�December 05,2011
SIGNED BY yet. Y K for the Town of Queensbury.
Director of Building&Code Enforcement
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p t d • -/ Revised 4/14/2010
OFFICE U YOe
TAX MAP N . T 0 V TN-0 F QUU� `�oY
BUILDING PERMIT FEE V
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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;F A VALID P RMI .
OWNER:` i 6LeariG27.2212 ,
J # * INSTALLER:
1 ' e
ADDRESS: 1 I' ._ ►_Iire DRESS: J` f'/ _- / ea_'._
PHONE NOS. --7 PHONE NOS. ��z.t ( 7✓
LOCATION OF INSTALLATION: 1 � S c -A e -cl
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW •
BEDROOMS (Gallons per bedroom) ' GARBAGE GRIND A
1980 or older X 150 = INSTALLED?
1981-1991 X 130 = ,30 SPA OR HOT TUB
1992-present X 110 = INSTALLED? A U
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROWNGGSTEEP SLOPE ' %SLOPE
✓ SOIL NATURE: SAND i. LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft1
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpq
(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: AZ2Z2 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: ----Na,2y4eit
❑ABSORPTI FIELD(WITH NO.2 STONE) Total length l6' ft. Each trench 612X ?i
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? fl/CC Size?
o 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 requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sa. • Se/` % ,posal O�;>(-. codeseaueensburv.net
//.'�j i 1 - VISIT OUR WEBSITE FOR MORE INFORMATION
ignature of Person Res. .nsible Date www.queensbutv.net
Town of Queensbury*Community Development Office*742 Bay Road, Queensbury NY 12804
I Rh_
Septic Inspection Report
Office No. (518)761-8256 Date Insp•Wo n
Queensbury Building&Code Enforcement Arrive: --L!' 1 ) • irpirii -part: a
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial•diNk7
NAME: �!C2c �- ��L ��'rF n • . 'IT NO.: - a
LOCATION: ON:
RECHECK:
Comments and/or diagram
Soil Ty•: oag../Clay
Type of Water: __,. •: ell Water
Waterli-pa�ration distance
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 al ft.1"-
Length
Length of each trench a> ft. - r -'WJE v E
Depth of trenches 3= ���
Size of Stone tJ
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank t-��� ! � \AU
Tank to Distribution Box ir` 5 Q -77.1
Distribution Box to Field/ Pit �Y 4 1 + 4,Q -j o \t. %LL
Opening Sealed: _ N
End Cap N WK) ��
Inlet/Outlet Pipes&Baffles N 7' � '` `-�'/ -
Manholes 12"or less below grade _N
[provide extension collar if Yes] Y_N C t-Ock (\�
Location/ Separations
f„,4%.71,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 R-A r Left Side Right Side Middle Front Middle Rear
S._ .
Approved
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 2910.doc
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