2010-379 TOWN OF QUEENSBURY
^� 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
4N
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100379 Date Issued: Tuesday, December 11, 2012
This is to certify that work requested to be done as shown by Permit Number P20100379
has been completed.
Tax Map Number: 523400-297-010-0001-021-000-0000
Location: 43 SHERATON Ln
Owner: STEVEN SCALIA
Applicant: STEVEN SCALIA
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 1.
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 Er\rcement
Planning Board or Zoning Board of Appeals.
" TOWN OF QUEENSBURY
It* 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100379 Application Number. A20100379
Tax Map No: 523400-297-010-0001-021-000-0000
Permission is hereby granted to: STEVEN SCALIA
For property located at: 43 SHERATON Ln
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: STEVEN SCALIA Septic Alteration Residential
MARY ELIZABETH MC CORMAC Total Value
43 SHERATON Ln
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-379
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,July 29, 2011
(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!
OFFICE USE ONLY
/1;-/ - I g
TAX MAP NO. ) 9 1PERMIT NO. — "'PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO R IEW BEFORE ISSUANCE OF A LALID
PERMIT.
OWNER: \5
64€£1 U(�I Se"//&
INSTALLER: ��
ADDRESS: 93 S47V ' I ADDRESS: jir-
70" 7 (., `
iC / —a-, e 2
PHONE NOS. PHONE NOS. V4?"(.:,f/esy/'
Li-
LOCATION OF INSTALLATION: JAe a G`1-O v1
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
BEDROOMS
1980 or older I, X 150 gallon per bedroom = (s�P C j GARAAGE GRINDER
INSTALLED?
1981 -1991 X 130 gallon per bedroom =
1992 present X 110 gallon per bedroom = SPA OR HOT TUB
INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope 'Y`�
SOIL NATURE: Sand Loam Clay Other \ c
✓ GROUNDWATER: At what depth? ^,
,\Qc)
v BEDROCK/IMPERVIOUS MATERIAL: At what depth? / \ I
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is per minute per inch. /
(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: f`�
AO 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? 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.
(,,A' 1 7''
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Septic Inspection Report 3 (3'-
Office No. 518 761-8256 Date Ins on Z 3 d Di o r
eIF'd: G" -
Queensbury Building&Code Enforcement Arrive: kr17 • 111 D-':rt: .
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial ISArr
NAM40:A..5
O` GP` Ar Q P "NO.: tit _37 Ci
LOCATION: q',51,ereft-71— / it.. :PECT ON: 7 SIMI ?"610
RECHECK: 'RIJIA ( e
Comments and/or diagram
Soil Type: Sand Sit1 Clay
Type of Water: Municipal VISAirapr
Waterline separation dis • e- ft.
Well separation distance <5 4 ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length
Length of each trench
001.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank `1 NCAA �C)
Tank to Distribution Box " ! C VAD Tc 1-t c c
Distribution Box to Field/ Pit NQ,4 Pin 0(--
Opening Sealed: Y____14
End Cap Y N
Inlet/Outlet Pipes&Baffles _N
Manholes 12"or less below grade _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 N
Engineer Report and As-Built _,_•,Y N
ETU Maintenance Contract Y N
provided
Location of Syste on Property:
Fron ' ear Left Side Right Sid- Middle Front Middle Rear
i-mUse S • s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Foims\Inspection Fomes\Septic Inspection Report_03 29 10.doc
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