2010-134 .41111 '` TOWN OF QUEENSBURY
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: P20100134 Date Issued: Tuesday, December 11, 2012
This is to certify that work requested to be done as shown by Permit Number P20100134
has been completed.
Tax Map Number: 523400-295-006-0001-004-000-0000
Location: 1145 WEST MT. Rd
Owner: EDWIN & YVONNE ALLEN
Applicant: EDWIN & YVONNE ALLEN
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 "' ! ) J /
property owner of the responsibility for compliance with Site Plan, ;' ()AI/ A'
Variance, or other issues and conditions as a result of approvals by the
Director of Building&Code nforcement
Planning Board or Zoning Board of Appeals.
41h TOWN OF QUEENSBURY
Fora 742 Bay Road,Queensbury NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100134 Application Number. A20100134
Tax Map No: 523400-295-006-0001-004-000-0000
Permission is hereby granted to: EDWIN &YVONNE ALLEN
For property located at: 1145 WEST MT. 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: EDWIN &YVONNE ALLEN
1145 WEST MT. Rd Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY, NY 12804
Plans &Specifications
2010-134
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, April 15, 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 the To Queens ry; Tihursday,April 15, 2010
SIGNED BY 11
- for the Town of Queensbury.
Director of Building Coo nforcement
- --------Z;
Z 75-. (-/-
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OFFICE USEONLY ___- _ _ :mowTAX MAP NO. �'i \Lii L,h-- [j
�,
PERMIT NO. PERMIT FEE
APPROVALS: ZONING
-- - TOWN CLERK �;I: A� 8 2010 1
.�i' I1...,J
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APPLICATION FOR SEPTIC _. C� bifs=i�. = ? ._;
DTIC DISPOSAL SYSTEM B' ILD`Nr—s P ,„01DE
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
OWNER: _ J
Ad
INSTALLER: t C / < c...4‘
C/ ADDRESS: � 6 � 62
PHONE NOS. L5--F 3 , P
PHONE NOS. i —
•LOCATION OF INSTALLATION:
YEAR BUILT NO.OF X COMPUTATION=
BEDROOMS RESIDENCE INFORMATION:
1980 or older = TOTAL DAILY FLOW
X 150 gallon per bedroom GARBAGE GRINDER
1981 -1991 X 130 gallon per bedroom INSTALLED?71/__Q_____
1992-present ' =
„ X 110 gallon per bedroom ' i SPA OR HOT TUB
PARCEL INFORMATION: INSTALLED? _
✓ TOPOGRAPHY: Flat rolling
Steep slope, %Slope4
✓ SOIL NATURE: Sand L /'/�
oarr��--1 Clay Othe�
✓ GROUNDWATER: At what depth?---f
✓ BEDROCK/IMPERVIOUS MATERIAL:
At what depth?
✓ DOMESTIC WATER SUPLY:
Municipal Weil
(if,weli: Water supply from any septic
✓ PERCOLATION TEST: Rate isA___ system absorption is--�_ft.)
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 a
TANK SIZE: / GALLON (MIN. SIZE IS 1 00 PProved subdivision).
0 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 len
gth2QcZft. Each trench _X S® )
O SEEPAGE PIT(S) (WITH NO. 3 STONE)
How many? ,
❑ ALTERNATIVE SYSTEM BSize?
Bed or other type? Al
❑ HOLDING TANK SYSTEM Total required capacity? A/A
Tank size?___ZZA____ Number of tanks?
I NOTE: ALARM SYSTEM AND ASSOCIATEDED ELECTRICAL
.
li
APPROVED ELECTRICAL INSPECTION RICAL WORK MUST BE INSPECTED BY
::.:.....:.....PROVED...ELECR:.:A NS E, AGENCY. PLEASE REVIEW A TOWN
For your LIST PROVIDED.,:,
protection, please note that pursuant to Section 136-29 of the Code of the Town of Ouaanch::.,,
permit or approval granted which is based upon nr is e.,,..._, ._
fails irc 4., .,,...1__ _ .
('73 frid67, .
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Septic Inspection Report
Office No. (518) 761-8256 Date Insectiorarequ -z^
Queensbury Building&Code Enforcement Arrive: . o k a ' • o ►-part: a
742 Bay Rd., Queensbu , NY 12804 Inspector's Initials: '--
NAME: A itax"..__) • NO.: •
LOCATION: �l r 1��`5� &. � �%t ' 'ECT ON: Asi1
RECHECK:
Comments and/or diagram
Soil T •.= '• ••m/Clay
Type of Water( •.I ell Water
Wate ine separation distance I 0 ft.
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 2-00 ft.
Length of each trench `4 C- ft.
Depth of trenches ' 2 -. ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 4 " t-A0
Tank to Distribution Box l,t "
Distribution Box to Field/ Pit )4 " PJC �E
Opening Sealed: %✓Y N _
End CapN BUILI
Inlet/Outlet Pipes&Baffles y N
Manholes 12"or less below grade ✓Y_N
[provide extension collar if ] Y—N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plo
Engineer Report and Y N
ETU Maintenance Co _ - Y N
provided
Location of System on Property:
Front ar Left Side Right Side Middle Front Middle Rear
S stem Use Sta 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 Repor _03 29 10.doc
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