2010-457 TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902
� � (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100457 Date Issued: Tuesday, September 21, 2010
This is to certify that work requested to be done as shown by Permit Number P20100457
has been completed.
Tax Map Number: 523400-308-005-0001-005-000-0000
Location: 38 TWIN MOUNTAIN Dr
Owner. MATTHEW D'AMBROSIO
Applicant: MATTHEW D'AMBROSIO
This structure may be occupied as a:
Septic Alteration Residential
By Ogler of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (DZ.. ('"k° '
+
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.
441111141tTOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100457 Application Number. A20100457
Tax Map No: 523400-308-005-0001-005-000-0000
Permission is hereby granted to: MATTHEW D'AMBROSIO
For property located at: 38 TWIN MOUNTAIN 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: MATTHEW D'AMBROSIO
38 TWIN MOUNTAIN Dr Septic Alteration Residential
QUEENSBURY,NY 12804-0000 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
2010-457
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, September 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 th own f Qu b 1y, frr a .esday, September 15, 2010
�dSIGNED BY ‘ for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010
OFFICE USE ONLY '
cow
TAX PPod l e5.5.--/ s PERMIT NO._/O . ERMIT FEE L 5-
— ,
APPROVALS: ZONING _ TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFO E W RK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OFA VALID PERMI . D ,,/�j�„ `')W'
OWNER: k. ry WA
��1 r t INSTALLER: `��_� ,c S(/!�(( (
ADDRESS: 3 TC-4 (- IA.. ( ADDRESS: 0) (tO C�.0 C (&c e''c- $
PHONE NOS. / , �� ,..).. 0,,,„„(__ ADDRESS:
PHONE NOS. .29 r-t/1 t
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X (Gallons per bedroom) = TOTAL DAILY FLOW GARBAGE GRIN
ri
1980 or older Y X 150 = /Cl dO INSTALLED? /
1981 -1991 X 130 = VVV SPA OR HOT
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING I STEEP SLOPEN4 %SLOP
✓ SOIL NATURE: SAND LOA / 4A CLW OTHER
✓ GROUNDWATER: AT WHAT DEPTH? 1 A'
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT✓DEPTH?,/l
I DOMESTIC WATER SUPLY: MUNICIPAL,/ WELL (If well:water supply from any septic system absorption is`Qd ft)
✓ PERCOLATION TEST: RATE IS "' ))) PER MIINUTE PER INCH[mpi]
(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: /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:
eliiiscBSORPTION FIELD(WITH NO.2 STONE) Total lengt4I ft. Each trench d X 4'
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? _ Size? .104.
0 ALTERNATIVE SYSTEM Bed or other type? /1/
i S� I
0 HOLDING TANK SYSTEM Total required capacity?//XL— 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 regulations with respect to this application and agree
to abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanita e Disposal Ordinance. 9//
rcodesqueensburv.net
/Lir— c{/ a`) VISIT OUR WEBSITE FOR MORE INFORMATION
«l www.queenabutynet
Signature of Person Responsible
Town of Queensbury* Community Development Office* 742 Bay Road, Queensbury NY 12804
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection req •-iv •:
Queensbury Building&Code Enforcement Arrive: 2=1 a Ir •-part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: 14/h_�r0S1(„�
LOCATION: )2) IT NO.:? - T,h /1471-- SPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance 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 ft.
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
Separation of Pits ft.
Conforms as per Plo N
Engineer Report a As-Butt.2 Y N
ETU Maintenan _Y N
provided
Location of System on Property:
Front R;.r Left Side Right Side Middle Front Middle Rear
em lS .s .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspecdon Forms\Seplic Inspection Report_03 29 10.doc
Ripeline Specialists JOB conti
E3P4 SHEET f �,
NO.: sitPILt OF
CALCULATE/1:44n
ALCULATED DATE
Everett J. Prescott, Inc. SCALE
4'iit Pit Ra
14.4
I Lit
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n-t.., ► /z S.0 to 111 C re,
H av5" i 1 Y2..
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspectipn u '"0 , -••
Queensbury Building&Code Enforcement Arrive: , •/I D .rt: /' a •
�J ,
742 Bay Rd., Queensbury, NY 12804 Inspector's'Ini ' Is•
NAME: \-21 t'\I`k'2,? C2 k1-Th P RM NO.: rC%-`Lk i'> (
LOCATION: -=.�r� L \vti —\' , I P CT ON: (A - \,-; .1U
RECHECK:
Comments and/or diagram
Soil Type: m/Clay
Type of Water ,: r Well Water r I
Wat ne separation distance ..s ft.
I separation distance ft.
(
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length _Z ft.
Length of each trench ft.
Depth of trenches 1 • ft.
Size of Stone = Z
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 4 ,. Lp
Tank to Distribution Box i t r
Distribution Box to Field/ Pit �'� `T-t
Opening Sealed: N
End Cap _..._N
Inlet/Outlet Pipes&Bafflesei,
�N �
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] Y N Jb ,
Location/ Separations L
Foundation to tank .�Z f ft.
Foundation to absorption 7 it.
Separation of Pits .
Conforms as per P la _Y
Engineer Report an As-Bui _Y , N
ETU Maintenance ract _Y_ N
provided
Location of System on--Property:
Front Rear r te__— Right Side Middle Front Middle Rear
em Use 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 Report_03 29 10.doc
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