2010-135 gat TOWN OF QUEENSBURY
WON742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100135 Date Issued: Thursday, April 22, 2010
This is to certify that work requested to be done as shown by Permit Number P20100135
has been completed.
Tax Map Number. 523400-301-012-0003-037-000-0000
Location: 357 DIXON Rd
Owner. JANE ST. ANDREWS
Applicant JANE ST. ANDREWS
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&Code Enforcement
Planning Board or Zoning Board of Appeals.
" TOWN OF QUEENSBURY
For*, 742 Bay Road,Queensbury NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100135 Application Number. A20100135
Tax Map No: 523400-301-012-0003-037-000-0000
Permission is hereby granted to: JANE ST. ANDREWS
For property located at: 357 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: JANE ST. ANDREWS
202 FULLER Rd 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
2010-135
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, April 14, 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.)
f
Dated at th Town Qu " ., /4 . i nesday, April 14,2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
/ • �� ,.'2 __ OFFICE USE ONLY _- ---- ::f -a- - -
TAXMAPNO. 11
PERMIT NO. / !-LRMIT ' ,FEE I x) �S ��
APPROVALS: ZONING
TOWN CLERK , 0
"- """ ' , -1:. -, FNSBURY
APPLICATION "" ;. ;Sr_�_• z CODESFOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT
CT TO REVIEW BEFORE ISSUANCE OF A VALID
OWNER: r
CA, INSTALLER: ��
ADDRESS: I /
/�
ADDRESS: C Q
PHONE NOS. 6 ,
PHONE NOS. r
A.
LOCATION OF INSTALLATION: i
YEAR BUILT NO.OF
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
1980 or older
1981 -r old X 150 gallon per bedroom = 0 INSTALLED?GARBAGE GRINDER
X 130 gallon per bedroom INSTALLED?TUB
1992-present =
'� X 110 gallon per bedroom = Ir i SPA AORL ED? TUB
INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rollin
gX_ Steep slopeZV,�
` %Slope__,a4
✓ SOIL NATURE: d
Loam_jA9 CIaY.2�t/�
Other_4X
✓ GROUNDWATER: At what depth?7#___&._
✓ BEDROCK/IMPERVIOUS MATERIAL:
At what depth?/
✓ DOMESTIC WATER SUPLY: Municipal Weil
-- ,4—(If,well: Water supply from ny septic
system absorption is—T,,d —ft.)
✓ PERCOLATION TEST: Rate is
er
te per inch.
(Test to be comp eted by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal
a licensed professional engineer or architect(unless installed in a Planning Board a
g p sal systems must be designed by
TANS S_: / 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 A
Each trench ,/�
1 AGE PIT(S) (WITH NO. 3 STONE) X
How many? I
❑ ALTERNATIVE SYSTEM Bed Size?
or other type? it 4
❑ HOLDING TANK SYSTEM
Total required capacity?
Tank size?AZ&__ Number of tanks?
'` NOTE: ALARM SYSTEM
APPROVED ELECTR ML ND ASSOCIATEDINSPECTED BY TELECTRICAL WORK MUST BE T
L INSPECTION I NAGENCY. PLEASE REVIEW LIST PROVIDEDOWN.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town
... ......................................::
permit or approval granted which is based upon or k rir7r,+,,,i :.. - wn of QUeen�h�Iry
failura to rr, i,.. . . .
Oiler i-s /1L-afS ?/67-
..
Septic Inspection Report
Office No. (518) 761-8256 Date Ins.- • request received:
Queensbury Building &Code Enforcement Arrive: Al = 1/ am/pic �" part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector' I itials: `J
NAME: 37: A-halite/L-1N,R„diPERMIT NO.: /O fLOCATION: 3�7 Z)ij&-) INSPECT ON: I/–/5=/c7
RECHECK:
Comments and/or diagram
Soil Ty.-• ;a . / Loam/Clay
Type of Water: alhipc..1/Well Water
Water) 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 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 G'
Tank to Distribution Box
Distribution Box to Field/ Pit n
Opening Sealed: _Y N
End Cap N
Inlet/Outlet Pipes&Baffles —N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] Y_-__-N
Location/ Separations
Foundation to tank Arri- 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:
Frontriiir.• Left Side Right Side Middle Front Middle Rear
em Use Stat :
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 Repor _03 29 10.doc
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5 Thi OF :.ateNSBURY
Reviewed-B
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Date. ___ .ra