2010-002 TOWN OFQ UEENSBURY
Fos
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100002 Date Issued: Tuesday, January 12, 2010
This is to certify that work requested to be done as shown by Permit Number P20100002
has been completed.
Tax Map Number. 523400-309-009-0003-053-000-0000
Location: 52 RHODE ISLAND Ave
Owner. RICHARD & GLORIA DAVIS
Applicant RICHARD & GLORIA 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 the + ' 4
property owner of the responsibility for compliance with Site Plan, 7%- g •3:rV
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
coics 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100002 Application Number. A20100002
Tax Map No: 523400-309-009-0003-053-000-0000
Permission is hereby granted to: RICHARD & GLORIA DAVIS
For property located at: 52 RHODE ISLAND 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: RICHARD & GLORIA DAVIS Septic Alteration Residential
52 RHODE ISLAND Ave
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-002
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,January 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.)
4 3+
Dated at th `Town of QuIe, sl lry; f/ ,.,. ednesday,January 06, 2010
SIGNED BY ud for the Town of Queensbury.
Director of Building&Code Enforcement
o
30 .7-3-,5-3OFFICE USE ONLY
TAX MAP NO. PERMIT NO2 /l�_ - �
PERMIT FEE
APPROVALS: ZONING �. JI/
TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORElV IT�
PERMIT. k
ISSUANCE OF A VALID
OWNER: i G r‘A D(.A U I
INSTALLER: 6 5 S ���t 0/A I it\
Hod c t .1 j to r,;^ !\v 1
ADDRESS: L�LIIF?� VVUvrt'/V �,
PHONE NOS. —1 5:5i—5 13 cc '
PHONE NOS. I '') - U
LOCATION OF INSTALLATION: RI R o d 5 l a r J `
YEAR BUILT NO.OF RESIDENCE INFORMATION:
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
1980 or older . = '� GARAAGE GRINDER
, X 150 gallon per bedroom
1981 -1991 X 130 gallon per bedroom INSTALLED?
1992-present X 110 gallon per bedroom - SPA HOTTUB
INSTALLED?
LEDD??
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steepslope %Slope
✓ SOIL NATURE: Sand
Loam Clay Other
✓ GROUNDWATER: At what depth? k_
✓ BE DROCK/IMPERVIOUS MATERIAL:
At hat depth?
✓ DOMESTIC WATER SUPLY: Municipal Well
(If well: Water supply from any septic
•,/ PERCOLATION
absorption is ft)
PERCOLATION TEST: Rate is per minute per inch.
(Test to be competed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivi io designed by
TANK SIZE �C� a Iston).
GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to t
each garbage grinder, spa or whirlpool tub. he size of the septic tank for
SY TEM TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total length__12 __ft. Each trench
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) Ho X
w many.? Size?
❑ ALTERNATIVE SYSTEM Bed or
other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? r0 __
..............a..............,...,......,........,...., Number of tanks? 1\f
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PRO VIBY A TOWN
DED. •
For your protection, please note that pursuant to Section 136-29 of the Code of the
..............:
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 nn hch&If of ..... ..__,._
! } SICif$it'%'
r -'
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received. (/
Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: • l '
/ (0 -
NAME: PERMIT NO. C
LOCATION: AP ie- a ,C'.. - {AiN Ave.INSPECT ON: 101
RECHECK:
Comments and/or diagram
Soil Type: ',5� / oath'/ Clay
Type of Water: Mcipal/Well Water
Waterline separation distance _ ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
z .�
Absorption Field: Total length .- ft.
Length of each trench :=*• ft.
Depth of trenches * .'-- ft.
Size of Stone W "2.....
Seepage Pits: Number 1
Size: '', x
t
Stone Size: i
Piping Size Type
Building to tank
Tank to Distribution Box i-:. -3' 0, ` 4 `;'t 'J
Distribution Box to Field/ Pit ' 1 It, . _ -`;)
Opening Sealed: XY_N - /
End Cap )s_Y_N
Inlet/Outlet Pipes&Baffles )Y^ N
Location/ Separations
Foundation to tank 2..C.„--' ft.
Foundation to absorption " S k ft.
Separation of Pits ' ft.
Conforms as per Plot Plan '�•• . N
Engineer Report and As-Built ��', _ N
Location of System on Property:
Front Re- > Left Side Right Side Middle Front Middle Rear
em s- ,. .
Ni, Approved
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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