Loading...
2010-329 TOWN OFQ UEENSBURY woro 742 Ba RoadQueensbury,NY 12804-5902 (518)761-8201 Y , Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20100329 Date Issued: Wednesday, July 14, 2010 This is to certify that work requested to be done as shown by Permit Number P20100329 has been completed. Tax Map Number. 523400-309-005-0001-018-000-0000 Location: 3 WINTERGREEN Rd Owner. VICTOR & PATRICIA VALLEJO, LE Applicant VICTOR & PATRICIA VALLEJO, LE 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& de E otcement Planning Board or Zoning Board of Appeals. 411114 TOWN OF QUEENSBURY V742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20100329 Application Number. A20100329 Tax Map No: 523400-309-005-0001-018-000-0000 Permission is hereby granted to: VICTOR&PATRICIA VALLEJO, LE For property located at: 3 WINTERGREEN Rd 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: VICTOR&PATRICIA VALLEJO, L TRACIE &DAVID VALLEJO Septic Alteration Residential 3 WINTERGREEN Rd Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2010-329 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,July 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 Tc o ee rye 'ri.'.y,July 09,2010 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement For an EPA homeowner's guide: htto://www.epa.gov/nodes/pubs/homeowner gu'•e long customize.adf 0 / ,_ 1 F OFFICE USE ONLY C yi,": �(,- TAX MAP NO. PERMIT NO._ //./7:: �/PERMIT FEE::- ` ;! APPROVALS: ZONING TOWN CLERK f APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. /� / / ',, OWNER:_ V�-��c--�9 INSTALLER: L� / s/ "''-(1&-/"S.— 412 4, C..� ADDRESS:,_t(...,),_&217-4A ,e,i- ' J4) ADDRESS: e J -3�J ls-41 6f PHONE NOS. 7 / 7--9/ �d P PHONE NOS. 79 - 0,P ---s--' LOCATION OF INSTALLATION:3 6-)i"'"e 4'zA `` RESIDENCE YEAR BUILT j NO.OFI BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW INFORMATION: 1980 or older 3 X 150 gallon per bedroom = `f SI) GARBAGE GRI�ND�'Ej R INSTALLED?_f.N____ 1981 -1991 X 130 gallon per bedroom = 1992-present X 110 gallon per bedroom = SPA OR HOT TUB INSTALLED? J PARCEL INFORMATION: / ✓ TOPOGRAPHY: FLAT ROL G v STEEP SLOPE SLOPE % ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WAS SUPLY: MUNICIPAL ✓✓_ WELL___(If well:water supply from any septic system absorption is:( ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE 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). TANK SIZE: 1 ©vim 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: / r ACsiBSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X ‘3.--0 ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ALTERNATIVE SYSTEM Bed or other type? o 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 regulations with respect to this application and agree QUESTIONS? CALL 761-8256 OR EMAIL to abide by these and all requirements of the Town of Queensbury codesAqueensburv.net Sanitary Sewage Disposal Ordinance. VISIT OUR WEBSITE FOR MORE INFORMATION (Ft" 0 i , j www.queensburv.net 4 /7//d ignature of 'erson Responsible Date Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804 /�- ( /� .e ' S ,&#r-/ / te• "` Septic Inspection Report Office No. (518) 761-8256 Date Ins•- 'o—• �r - Queensbury Budding &Code Enforcement Arrive: 'v '�. �,!4,y�r •.-part: 1 VIr .y1,'1 742 Bay Rd., Queen bu NY 12804 Inspector's Initia NAME: 0 'r'MIT NO.: /0 - 2 7 LOCATION: IAN e - . SPECT ON: 7.-/".-3 -/Q RECHECK: Comments and/or diagram Soil Type ,•, •.m lay Type of Water: •- ell Water Wa - -paration 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 -21:)--) ft. Length of each trench 4412.51) ft. Depth of trenches Z ft. Size of Stone Z. Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank E5TA tv Tank to Distribution Box t} Qe_, 35— Distribution 5— Distribution Box to Field/ Pit y T Q IL-3 Opening Sealed: N End Cap N Inlet/Outlet Pipes&Baffles N Manholes 12"or less below grade _Y_N [Prov', - . • : ' - Location/ Separations Foundation to tank Vii' 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: Froniery.5 eft Sid Right Side Middle Front Middle Rear stem 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 4 -- - i �fyam E 4 Y-r r 11 i{ If. I have seen or observed, or believe I saw evidence of, all ob shouses wells, trees,_ €e►ve , etc,,f , shown or this document. Iajsn represent that i ve e - he is set f-rt; o t tip rats a - A T t iI I F i L___, ' , ,t > ,..,„r„,,b,„,.,,,,,.., 4R0 Y. _ i a- CSLJUL1#1 1:1-.) 4s ifs , - 3 i I t I E 7