2010-122 TOWN OF QUEENSBURY
!kw742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100122 Date Issued: Tuesday, April 13, 2010
This is to certify that work requested to be done as shown by Permit Number P20100122
has been completed.
Tax Map Number. 523400-296-009-0001-060-000-0000
Location: 8 CEDARWOOD Dr
Owner. ROBERT & DANA ROHNE
Applicant ROBERT & DANA ROHNE
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 fi
(�
property owner of the responsibility for compliance with Site Plan, atc
Variance, or other issues and conditions as a result of approvals by theDirector of Building&Co a Enfo ement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100122 Application Number. A20100122
Tax Map No: 523400-296-009-0001-060-000-0000
Permission is hereby granted to: ROBERT &DANA ROHNE
For property located at: 8 CEDARWOOD 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: ROBERT &DANA ROHNE
8 CEDARWOOD Dr Septic Alteration Residential
QUEENSBURY, NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-122
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,April 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 To • • • eensb , •s,.y,April 06, 2010
SIGNED BY , r for the Town of Queensbury.
Director of Building& •de orcement
�� ,� 6OFFICE USE ONLY i;..'' �. �.� r - . -.�.__,..
TAX MAP IVO. PERMIT NO. PERMIT F 2 ' ; �,
jG �7 P RM EE ;�, APRt.. 2010
•
,
APPROVALS: ZONING TOWN CLERK I; ; ;r,,_,i -4w, �s ; �
6�
I. ,.,3 Ij�',aA ; L�E:�.:
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: OC /t-f fil-olvti f ,- INSTALLER: 1-17hwjgif-efiiL:1 CF:
ADDRESS: el,tZ) 11-7( Uza�`)) "-Dt`L-- ADDRESS: 1 v AC 2 ZY C f
PHONE NOS. 792,/- o c c 3 PHONE NOS. 7?6 r o p c
LOCATION OF INSTALLATION: P 0/7-0 An-t,I)Ji)
RESIDENCE INFORMATION:
NO.OF
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW
BEDRQOMS GARBAGE GRIM
1980 or older 7/� X 150 gallon per bedroom = 6 o) INSTALLED? /�.l\/
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUBio\)
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling
Steep slope %Slope
✓ SOIL NATURE: Sand ! Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what/depth?
✓ 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).
,X,sc/N 6
TANK SIZE: ( 0 0Li 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:
O ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
..SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? P-- Size? 10 .? P
O ALTERNATIVE SYSTEM Bed or other type?
O HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
II NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
11 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
(2-.00) i - ,3 t\ktre ---11,-7 .
---
Septic
Septic Inspection Report
Office No. (518) 761-8256 Date Insiorequest received:
Queensbury Building &Code Enforcement Arrive: ��� am/pmpa am/pm
742 Bay Rd., Queensbury, NY 12804 Inspect is Initials:
NAME: [ ,l2 PERMIT NO.: /0 l 7
LOCATION: --1.- in--rib : INSPECT ON: -- 7 -1D.
RECHECK:
Comments and/or diagram
Soil Ty•.• .•. / .am/ Clay
Type of Water unicipal ell Water
Wat-rline se•- :tion distance ft.
- - •aration distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone _
Seepage Pits: Number
Size: x
Stone Size: ,1i `l')
Piping Size ,c
Type
Building to tank &/c/� '
Tank to Distribution Box t1 ie.- 5 -
Distribution Box to Field / Pittt 1
Opening Sealed: Y N
End Cap �N
Inlet/Outlet Pipes&Baffles , Y N
Location/ Separations
Foundation to tank ri/ - .
Foundation to absorption 10 ft.
Separation of Pits ft.
Conforms as per Plot Plan . Y N
Engineer Report and As-Built —Y— N
Location of Syst: on ,roperty:
Front Rea Left Side Right Side Middle Front Middle Rear
S -m U - ._ u::
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
._. ..
.......—.
rved, or believe I saw
:
i p,
1 ', ‘ t -,--!•::-.7'-'#'
.
1
o
------ --
vv fri-te---
1
c) .c,N,Ill
I
(r.„)
\ -
U
, -„....p
..:.1 4.
,. r
I
1
tI •
k•-)
•
TOWN OF QUEENSBURY
BUILDING & C21,- ... N
low-
Reviewed By:
Date:
kr 4)
i