2011-355 L
_W
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
NNW Community Development-Building & Codes (518) 761-8256
CERTIFICATE OF . COMPLIANCE
Permit Number: P20110355 Date Issued: Wednesday, August 24, 2011
This is to certify that work requested to be done as shown by Permit,Number P20110355
has been completed.
Tax Map Number: 523400-301-006-0002-060-000=0000 .
Location: 24 WESTLAND Ave "
Owner: JAMES DAVIS
Applicant: JAMES DAVIS
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 theQ `
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: P20110355 Application Number: a20110355
Tax Map No: 523400-301-006-0002-060-000-0000
Permission is hereby granted to: JAMES DAVIS
For property located at: 24 WESTLAND 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: JAMES DAVIS Septic Alteration Residential
HEATHER MATTISON Total value
24 WESTLAND Ave
QUEENSBURY,NY .12804
Contractor or Builder's Name/Address Electrical Inspection Agency
BRADLEY'S SEPTIC SERVICE
654-6318
47 HACK Rd
CORINTH NY 12822-0000
Plans&Specifications
2011-355
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,July 26,2012
(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 Tow eensbu TP/e�Adpy',July 26,2011
SIGNED BY rr y for the Town of Queensbury.
Director of Building& , ode En orcement
DN01
OFFICE USE ONLY 4
TAX MAP NO. —I Q PERMIT NO. PERMIT FEE ND, JUL 2 2011
APPROVALS: ZONING TOWN CLERK TOWN OF QUEEN_. Y
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID P RMIT. S S
OWNER: INSTALLER:
ADDRESS: �I�yW�ST"l�in(� ' I" `� ADDRESS: VZp
PHONE NOS. J(� 2 �( PHONE NOS.
LOCATION OF INSTALLATION,
RESIDENCE INFORMATION:
YEAR BUILT. NO.OF X COMPUTATION ) = TOTAL DAILY FLOW
BEDROOMS Gallons per bedroom GARBAGE GRINDS
1980orolder 7 X 150 = &(,j'� INSTALLED? // 4_
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? I V 4
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
✓ 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: L 3�A 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 ft. Each trench X
SEEPAGE PIT(S)(WITH NO.3 STONE) How many?2 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 rea the regulation ith respect to this application and agree
to abide b these and all quirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary ewage Di o Ordinance. codes0gueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
S g ature of P rs n Responsible Date www•aueensbury.net
Town of eensbury* Community Development Office*742.Bay Road, Queensbury NY 12804
Septic Inspection Report
Office No. (518)761-8256 Date Inspection 'request received:
Queensbury Building&Code Enforcement Arrive: am/pm DeDepart:j p am/pm
742 Bay Rd., Qu , sbury, NY 12804 Inspector's Initials: �j l
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type:
Loam/Clay
T of Water: un i Well Water
Waterline paration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/- _NYIN 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 Tpe
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: N
End Ca _ N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade _Y=N
rovide extension collar if Yes Y N
Location Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits 26 ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built _Y N
ETU Maintenance Contract Y_N
provided
Location of SystrRear
perly:
Front 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
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