2010-501 TOWN OFQ UEENSBURY
wow742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100501 Date Issued: Thursday, November 04, 2010
This is to certify that work requested to be done as shown by Permit Number P20100501
has been completed.
Tax Map Number. 523400-308-006-0001-021-000-0000
Location: 17 MICHAELS Dr
Owner. JOSEPH & ALICE SULLIVAN - LE
Applicant: JOSEPH & ALICE SULLIVAN - 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 theav 4
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.
" TOWN OF QUEENSBURY
FAT 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100501 Application Number. A20100501
Tax Map No: 523400-308-006-0001-021-000-0000
Permission is hereby granted to: JOSEPH &ALICE SULLIVAN- LE
For property located at: 17 MICHAELS 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: JOSEPH &ALICE SULLIVAN - LE
MELISSA SULLIVAN ET AL Septic Alteration Residential
17 MICHAELS Dr Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
- 2010-501
SEPTIC ALTERATION RESIDENTIAL
$25.00 PE1 11T FEE PAID-'TfiIS PERMIT EXPIRES: Wednesday, October 19,2011
(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 T of eens ry' 1Ti ctober 19,2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
----,......--**-Am.
_----- - - -___...1_________,
f X <**eSZIEE)
i a o i
1 --- -----------50 i
1106 Z S
--1.7.--- -- t -- --- --- -7' --- - '-- - - -' — -- 1
' .' ..,.... ........., "'=-- -...,,„ ....- .......,, -...... -...,--- ....... ..,.., ,......... ......- -....-. ,.,-......, -,......- -...... ............ ,..........- ,:•••••-;
I ......, ,..._ ,,...,, „..„„.,_. ,-- .... -...-, -,- --,.-- ........ ..... ...... ....... *
i I
1 . MC'W iC.'/E 4 D --7 A-
I f
)
,-,, ',-, ;•: 's-- -4- , ri-c-'-4- %.,,zi I
-N a
. , ,,,,, . --, . * 0 . . 4 4,0,e 1
,tk. __,.._.,„ , -. _ _,
6 I t...,- "751\-1 i' J1:f :11 b;-44.-Za Sro Ale i
) •,',.. I --i-- '_: L._ , ,_ i
i f
i .
\ ,
3 \ .
S EC 7/ty Al A A I
\ _ ,
N i
. .
...\
t ,
.
CP\
\ .
/
1 \ /
\ +
I • ,
. {
!
1
1
)
A/140 5 c A L. e !
0 i
,.. : h .
,
i I
1 1
1 .
—
I
1 , .
, 1
[---- — .
i I
+ .. ...
:.-
-
„ ......,_I
r
/44 / HALE5 D.Ritifie- . ....._
...)ac it4/VI'V
Revised 4/14/2010
OFFI�FI��CE USE jONLY �� / /
TAX MAP NO. PERMIT NO. / S0/ PERMIT FEE E C '�! `
• APPROVALS: ZONING TOWN CLERK ' # ys,
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: I ' s1 ' n
�l11U
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJ:CT T ,..REVIEW BEFORE
,'
ISSUANCE OF A VALID PERMIT. J rOWNIJFl�-oriErSBURlin'OWNER: i9 S
."1 V to)/ I L) INSTALLER: J�i Xs 1 f 4 CC. • ' 4 �J E,
BUILT .
ADDRESS: 1 7 i/ i',//i s, D1--c- ADDRESS: /D, 1✓c & Z. e 2:e),..,5),---04./is /t-f//z. e
PHONE NOS. 7qz—5 2 o4 -�/j bPHONE NOS. 79Z '-7 Z 7
LOCATION OF INSTALLATION: 1 7 /i` iC 14144 L
S R
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? '-'n
1981 -1991 3 X 130 = 3/0 SPA OR HOT TUB
1992-present X 110 = INSTALLED? itVD
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING ./4. STEEP SLOPE %SLOPE
rir.,4�
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL A_ WELL (If well:water supply from any septic system absorption is: ft)
,/ Y
PERCOLATION TEST: RATE IS -+,=. PER MIINUTE PER INCH[mpi] F' `� J 3`+7 v t 5 c4,.. Paces
(Test to be completed by a licensed professional engineer or architect) ,tr!-f ti 1/"1`•'`7"'‘3`''�6`-----' Grp
FiL11.
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: //),.,d 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: /
11-ABSORPTION FIELD(WITH NO.2 STONE) Total length lob ft. Each trench So X 2 4 .-
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
0 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
to abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sa. ry Sewage Disposal Ordinance. codesCa queensburv.net
IF cei. q AO f I VISIT OUR WEBSITE FOR MORE INFORMATION
ign ure of P-rson Responsible r,ate www.queensburv.net
Town of Queensbury* Community Development Office *742 Bay Road, Queensbury NY 12804
3 ) /0 /Z 71-)C-Sd17
P�
Septic Inspection Re• • r'
P
Office No. (518)761-8256 Date Ins•-•.• ;.-•,-1 -•:
Queensbury Building&Code Enforcement Arrive: 4. •-part: r • prr2
742 Bay Rd., Queensbury, NY 12804 Ins• -•l• s Int ,
- T
iNAME: ■ NO.:
LOCATION: 1* tkee IS !')r'
ON: /1- Z --/0
RECHECK:
Comments and/or diagram
• - • . /Clay
Type of , =
Waterline stparati asstance fes• a' ft.
Wel separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total lengthu 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 V--3")
Opening Sealed: • N
End Cap _ N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade
[provide exte
Location/ Separations
Foundation to tank
Foundation to absorption r h ft.
Separation of Pits ft.
Conforms as per • - _N
Engineer Report :nd As-B • ; Y_N
ETU Maintenance • • Y N
provided
Location of System on Property:
Front R r Left Side Right Side Middle Fro Middle Rear
stem
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 Repori;_03 29 10.doc
........----.„,—,........„„..„, , ,..., . ..
0 !,
-,..-
i
...,”
....,„., _ _,..,.....,.....
i 4
•„971;' C'
• '' 'H'''''.° 1! "?,-.'' '
.1/41- C,f1
.-,','., ;,-.• .,,,,,i"ii.4 14AC'S'ir're'A—'011.;3"i"...:1‘.j'10 1:1..:1;,1:4',....;-;'
..- ...., , .
i
•4‘.3
• '...1
•
i
' ,i,•.,
it)
I ,
I 1
•
.i7
i.,
f 1
1 1
1 ,
!
l3 „,f, , ,„1 .. •4 4
. • 1
4:4)
cr ,
. .
ss:. • • • , ..
,....
,...,,t
., .
,
, , • ; •
Y.) i
'1 , .,......-14.-4,41,--44,+•-. 4 ,,,,-, J-4 i IQ LI
,.-/'„r ' -j• ',,,
--„,
, i I . • ' H . ' 1
t tu
. ,
; f
! '„cc ''•! .; '' '-'1-,;„;',• t
..,.>
k ,
<.1
..„...,
. 11
a .
CY
, .
. .
i .
,i,-,
ci
11
1 i
\Z....1'
; , • 1 ,I
1
!, • C17.)
, 1
•
I
r•
I I i
• :
4,1
)
,. .t.,
, f 4
•
,...._.-- t tzlts i: i 4 ; .49 i
, '. ' 1 : '• .....
,„
, ' 1 •:.?.. 1 1 •-"••,4 , t
t
•
•
,.
C.)
,
,
,40
•,,...„
,
i.d
1 ,
. . i
. .
,....`
11 ,
1 1
i
1 1
, 1
i .
1 1
1 1
,
• ;
.
•-•,' 1 ”, i ;•;
i 1
1
--3- ,7.-:' ' r'"----- " ,
.-
-•
, I
, .,. ; ., ..............--...
• 1 1
':./....
. .,
.......
. /,..1
1 t
, 1
i J
.,
s _ ....._ ... _ ......._„............
---, ,
,1 !
.1/' _
'-,
. i
.... -- ...... ..
.
../
-