2010-538 o
TOWN OF QUEENSBURY
Fra
742 BayRoad, NY12804-5902761-8201
Queensbury, (518)
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100538 Date Issued: Thursday, December 20, 2012
This is to certify that work requested to be done as shown by Permit Number P20100538
has been completed.
Tax Map Number: 523400-308-005-0001-067-000-0000
Location: 15 MARIGOLD Dr
Owner: CATHERN R GRUNDLER
Applicant: CATHERN R GRUNDLER
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
(.-" J ,g3t"
Issuance of this Certificate of Compliance DOES NOT relieve the 11
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.
4 ` TOWN OF QUEENSBURY
F411.0 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100538 Application Number. A20100538
Tax Map No: 523400-308-005-0001-067-000-0000
Permission is hereby granted to: CATHERN R GRUNDLER
For property located at: 15 MARIGOLD Dr
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: CATHERN R GRUNDLER Septic Alteration Residential
15 MARIGOLD Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2010-538
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,November 09, 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 Qury; ui sday,November 09,2010
SIGNED BY < ueeG 1 for the Town of Queensbury.
Director of Buil.' : &Co Enforcement
D ,E, ri F_ TI of E
t�t.i� (� �ZO1Q � NoV O
Community Development ill e _ �i� i __ _
-;. Town of Queensbury • 742 B y Rcr4AtRueertsbury,-,N j Yor •12804 -----y
•---....81-1/1 O _.LLr00ES
RY
Office Use Only
TAX MAP NO. 7( . - _1 l- 7 PERMIT NO. ,_/( ) -)? - PERMIT FEE_c.."-.-- 4''�
APPROVALS: ZONING_______ -- TOWN CLERK___
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW FORE ISSUANC OF A VALID PERMIT.
OWNERC.11-A�r __�o Q Ir_a—12---A— INSTALLER: _Atli l d- L.-
ADDRESS:__/S. H A"R I. o CD 71 2 f(/L ADDRESS: f d(S t.''/ 22-9 6 F
PHONE NOS.7 _3-2 7 ? 9 PHONE NOS. / 9 6 r O j S O
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LOCATION OF INSTALLATION: 1S. 1 t R, _94_L7
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? NO
1981 -1991 S X 130 = 6 -5-:°
_ SPA OR HOT TUB
1992-present X 110 = INSTALLED?___W_
PARCEL INFORMATION: /
✓ TOPOGRAPHY: FLAT ROLL G_j[_ STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT EPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL +' WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS _____PER MIINUTE PER INCH[mph] (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: / '5"9v 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: /'
ElABSORPTION FIELD(WITH NO. 2 STONE) Total length 2-7%5- ft. Each trench `2 ' 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.
I have read the r::_ .tions with respect to this application and agree to
.. .. by these an. :I -quirem-n-. of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
'anit.ry Sewag @ is.••.I Orb, nce. codes(.queensbury.net
I' t ifyil°
VISIT OUR WEBSITE FOR MORE INFORMATION
•n. ure of Pers• Responsible Date www.queensbury.net
C l s -tom 1 : 3 o, ►. / -
Septic
Inspection Report
Office No. (518) 761-8256 Date Inspection requ : eiv=d: /�/�/�
Queensbury Building &Code Enforcement Arrive: \2. 4D a. .. '.-part: I .5 i a /�
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial.
NAME: G•2 v,k) NO.: I �3 g
LOCATION: f S- 1'''la2i yc�ib AT ; ve /IT
CTON: I ///O//�
RECHECK:
Comments and/or diagram
Soil Type: - • •.m/ Clay
Type of Watellgr Well Water V5 E.-N p6 v1 13-v
Waterline separa ion . r: ce \c ft. -it-
Well separation distance ft.
Other wells: _ ft.
Well Casing Length 50' +/ - Y N N/A
Absorption Field: Total length
Length of each trench iy ft. CAZ i L w V--
Depth of trenches i ft. �
Size of Stone �'Z 1D E f✓g
Seepage Pits: Number L_iNW 0? 1!-31/4.
Size: x
Stone Size:
Piping Size Type
Building to tank t,Lt{
Tank to Distribution Box Lcr `D.K)R-35
Distribution Box to Field/ Pit ` -`t, `7� P
Opening Sealed: '�Y N
End Cap
Inlet/Outlet Pipes&Baffles N
Location/ Separations
• Foundation to tank
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan N
Engineer Report and As-Built —Y N
Location of System on Property:
Front ear Left Sid Right Side Middle From Middle_Ram
System Use Status:
pproved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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/61)
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h.aveseen or observed, or believe I saw evidence of, I
eI)Iects such as houses, wells, trees, fences, etc., i
,
Oownp,this document I also represent that I have ' IP
T:,, 'fi!.',-in,lly c:asure , .i'- : listanci .et fcrth on the iagrmil."
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SIGIlATUR-- DATE . 441
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