2010-488 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100488 Date Issued: Wednesday, December 19, 2012
This is to certify that work requested to be done as shown by Permit Number P20100488
has been completed.
Tax Map Number: 523400-302-014-0002-052-000-0000
Location: 5 BULLARD Ave
Owner: DONALD & JOYCE BODAK
Applicant: DONALD & JOYCE BODAK
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
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 force nt
Planning Board or Zoning Board of Appeals.
41111A TOWN OF QUEENSBURY
cow 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100488 Application Number. A20100488
Tax Map No: 523400-302-014-0002-052-000-0000
Permission is hereby granted to: DONALD &JOYCE BODAK
For property located at: 5 BULLARD 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: DONALD &JOYCE BODAK
5 BULLARD Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2010-488
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, October 06, 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 own ee u .nesday,October 06,2010
avi0.
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
G _ _ OFFICE U Y - _
SE ONL _ ...
TAX MAP /
PERMIT NO. �`.
OLAEPERMIT FEE — ."
APPROVALS: ZONING j : -� �; •, v
TOWN CLERK % fel. " l iii '
T
PLIC WNOFC`" ______
APPLICATION SEPTIC __ g171tt�1���,j� , � :Y.. ,
TIC DISPOSAL SYSTEM PERMIT:
r. �. .
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
OWNER: OP Re). a
INSTALLER: - e VS `,e ;
ADDRESS: ' 8
�/ e_..2.-it.• " ADDRESS:
PHONE NOS. EL 0 — - ! _/12
PHONE NOS.
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
1980 or older X 150 gallon per bedroom = �
1981 -1991 �y
„, y GARBAGE GRI R
X 130 gallon per bedroom ``A r INSTALLED?
1992-present X 110 gallon per bedroom =
SPA OR HOT TU ,
PARCEL INFORMATION: INSTALLED?
✓ TOPOGRAPHY: Flat rolling
Steep slope %Slope
✓ SOIL NATURE:
Sand.___ Loam Clay__
✓ GROUNDWATER: Other
At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL:���� At what depth?
✓ DOMESTIC WATER SUPLY:
Municipal Well
(If.well: Water supply from any septic
✓ PERCOLATION TEST: Rate is /— L5-- 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 approved SIZE: r pproved subdivision).
GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of the se
each garbage grinder, spa or whirlpool tub. ptic tank for
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft.
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE How Each trench X
many?
❑ ALTERNATIVE SYSTEM Bed Size?
or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
,` NOTE:'.. . ...:.:...:...:.:...::...:...:.:.:. ... :.:.:.:.,•..,.:.::.:.,.,.,...,
ALARM SYSTEM ..:................:.:.:.:...:...:.. ..,.,...::•:.:.:......
APPROVED ELECT AND ASSOCIATED ELECTRICAL WORK MUST ,•PECT•,•.••. "•"
RICAL INSPECTION AGENCY. PLEASE REVIEWBE INSPECT BY A TOWN
For your protection, please riot LIST PROVIDEDD.
e that pursuant to Section 136-29 of the Code of the Town, rrf n
permit or approval granted which is based I innn -- . .
TOWN OF QUEENSBURY
s
PA 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
ET ; Community Development-Building& Codes (518) 761-8256
Inspections per Permit
Permit# P20100488
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
10/05/2010 Miscellaneous Septic Alteration Residential JENNIFER HENDERSON Staff
Misc 2010-488
permit entered
10/06/2010 Miscellaneous Septic Alteration Residential JENNIFER HENDERSON Staff
Misc 2010-488
permit issued
10/08/2010 Septic Septic Alteration Residential CHARLES DYER Staff
Approved 2010-488
replacement of tank only- 1000 gal
12/19/2012 Miscellaneous Septic Alteration Residential STAFF
Misc 2010-488
Septic approved-never closed out
CC issued today
\• •
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart:// )am/pm�i
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 60 �`�
NAME: 5eletek . B PERMIT NO.: a I I^
LOCATION: /5ulif /� INSPECT ON: /
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay /
Type of Water: Municipal/Well Water --'/Z �'o-1
Waterline separation distance ft.
Well separation distance ft. CJI 3 G I— 4/C3
Other wells: ft.
Well Casing Length 50' +/- Y N N/A kev-- y
. 0 C re" o/---
[150'to well required if NOl -
Absorption Field: Total length ft. tOCI
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: _,_,._•Y—N
End Cap Y_N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade 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 N
Engineer Report and As-Built _Y N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front R Left Side Right Side Middle Front Middle Rear
-mU - ! :
V 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 ReporX_03 29 10.doc
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