2010-072 ..41111A TOWN OFQ UEENSBURY
IFVFN 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100072 Date Issued: Monday, March 15, 2010
This is to certify that work requested to be done as shown by Permit Number P20100072
has been completed.
Tax Map Number. 523400-301-012-0002-028-000-0000
Location: 370 DIXON Rd
Owner. JONATHON WARNER
Applicant JONATHON WARNER
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& s de E :rcement
Planning Board or Zoning Board of Appeals.
Bay Road,Queensbury,Ba TOWN OF QUEENSBURY
A.
`fN NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100072 Application Number. A20100072
Tax Map No: 523400-301-012-0002-028-000-0000
Permission is hereby granted to: JONATHON WARNER
For property located at: 370 DIXON 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: JONATHON WARNER
370 DIXON Rd Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-072
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, March 08, 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 by; i : . ,y, March 08,2010
SIGNED BY oI \ for the Town of Queensbury.
Director of Building&Code Enforcement
For an EPA homeowner's guide: ,..rr,,y:^,-,--: ---2,:'„,-„-„--12_,,,"--,'- ., `�r
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TAX PERMIT I�`�/ /0 V / V-tfii\J�I� FEE G2:✓ $ mAR 0 5 2010 L
APPROVALS CONING f_)`^:WN _ER< Y t U
' : TOWN OF QUEENSBURY
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: Warner INSTALLER: The Rooter Guy Plumbing&Drain Cleaning
ADDRESS: 370 Dixon road ADDRESS: Po box 1274 Latham NY 12110
PHONE NOS. 518/307-3270 PHONE NOS. 518/792-2727
LOCATION OF INSTALLATION: Back Of house
RESIDENCE
YEAR BUILT
NO. X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
BEDROOMS
1980 or older 2 X 150 gallon per bedroom = 300 GARBAGE GRINDER
1981 -1991 X 130 gallon per bedroom = 0 INSTALLED? c
1992-present X 110 gallon per bedroom = 0 SPA OR HOT TUB
INSTALLED? No
PARCEL INFORMATION:
I TOPOGRAPHY: FLAT ROLLING ✓ STEEP SLOPE SLOPE %
✓ SOIL NATURE: SAND ✓ LOAM CLAY OTHER
I GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY:
MUNICIPAL I WELL (If well:water supply from any septic system absorption is:( ft)
I 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: 1000 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:
ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
®SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? / Size? yk/0
0 ALTERNATIVE SYSTEM Bed or other type?
0 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 — Eu STIONS? CALL 761-8256 OR EMAIL `----_
to abide by these and all requirements of t. Town of Queensbury codes@yueensbury.net ,
Sanitary Sewage •ispo - Ordinance.
_ VISIT OUR WEBSITE FOR MORE INFORMATION
`` www.queensbury.net —
Sign.. re o -erson Responsible Bat,
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'��',,., 111'„ ':' ();tcc,!shin'', NI, ii' ()IA •r.?,,'(ia PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
SIDE PROPERTY LINE
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/5/ Departs am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: r
NAME: �rii . PERMIT NO.: 20/0-(77 ?,
LOCATION: 3F-C) Sr7 �__3 INSPECT ON: 3- z- -/0
RECHECK:
<----N Comments and/or diagram
Soil Ty. -. . •. Loam/ Clay
Type of Water: M WO) Well Water
Waterline ation distance y 1 ft.
Well separation distance , ii,(� .
Other wells: Oft
Well Casing Length 50' + / - Y _ N N/A aciiatalLit,037C
Absorption Field: Total length ft.
Length of each trench ft. `
Depth of trenches ft.
Size ofN Stone0
Seepage Pits: Number oftS
• C 1C
Size: t x. ( 7—
Stone Size: � � 01[
--'k-
Piping i``ze e� �1 1
Building to tank
Tank to Distribution Box 1 , f
Distribution Box to Field/ Pit1Z3h< —`�
Opening Sealed: N ``�
End Cap TY^N
Inlet/Outlet Pipes&Baffles _Y Nl A- d
Location/ Separations
Foundation to tank ,i.L ft.
Foundation to absorption ft. i
Separation of Pits . �ft. ,N
Conforms as per Plot Plan N % i!^ . �'
Engineer Report and As-Built V N i -�
Z
Location of System •• • operty:
_-.mO^,� P
Front Rear Left Side Right Side Middle Front Middle Rear
-mUe _ L •
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Off e
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
keefftei7Septic 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:
NAME: OrA PERMITNO.: /O-072
LOCATION: Q /3,)(-01- - INSPECT ON: /O-/()
RECHECK:
Comments and/or diagram
Soil Type: and)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 � '�-' �-'•
Absorption Field: Total length ft.
Length of each trench ft. ^�,� „,
Depth of trenches ft. �'`
Size of Stone
Seepage Pits: Number 't ,�J}
Size: x 1 t 1
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
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft. 601 , 1/ rj tt""44
Separation of Pits ft.
Conforms as per Plot Plan —Y_N
•
Engineer Report and As-Built Y— N � f- �
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S -m - s:
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
SEWAGE SYSTEMS: SEPARATION REQUIREMENTS - SEEPAGE PIT
POND 0*,
p"tOp-a .—
WELL IN
Please refer to Queensbury Town ( WGA ) 15'MIN
Code, Sewers and Sewage Disposal, °`IN%
Appendix A, 136:A1 and Appendix B, ,s*at,
136:A3,for more detailed information 'c� Imo=
on SEPARATION REQUIREMENTS. Z `N17;t'
G
se I
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• mSEEPAGE PIT • 20 M`N10�\a HOUSE r
ii./ mQ1� • I L
Cr z O
4 • Z • SEPTI'TANK GARAGE
DISTRIBUTION BOX PA
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PROPERTY LINE --
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