2015-219 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150219 Date Issued: Monday, June 15, 2015
This is to certify that work requested to be done as shown by Permit Number P20150219
has been completed.
Tax Map Number: 523400-301-012-0002-013-000-0000
Location: 22 COLONIAL Ct
Owner: WILLIAM & SHELLY ALEXANDER JR
Applicant: WILLIAM & SHELLY ALEXANDER JR
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 (DJ
,Ot--
property owner of the responsibility for compliance with Site Plan, �d
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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
IFITM
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150219 Application Number: A20150219
Tax Map No: 523400-301-012-0002-013-000-0000
Permission is hereby granted to: WILLIAM& SHELLY ALEXANDER JR
For property located at: 22 COLONIAL Ct
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: WILLIAM& SHELLY ALEXANDER Septic Alteration Residential
22 COLONIAL Ct Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
BP 2015-219
Residential Septic Alteration
$40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Sunday,May 29,2016
(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 To o eensbF 's .,, May 29,2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
•
SEPTIC DISPOSAL PERMIT11 P� Office Use Only
DATE F eceived
2 9 2015 .-fax Map ID Zxc►• 12.-2-13
TAX MAP ID Permit No. vZGl S
TOWN OF QUE`NSBUP 6
Permit Fee
LOCATION OF INSTALLATION 2 2 Approvals:
APPLICANT , SX e4 .#44eNGl r PHONE/E-MAIL
ADDRESS `C���/'/14 ( d GC/' /—
/ o� L
INSTALLER/BUILDER: /-� C'{�'/v<�l/' i���c JC' PHONE/E-MAIL 7 ?AO
ADDRESS: /6"". 2 Z9 7,-4/f /`-'2
OWNER Sher- n d(4 1//9/"��e/ PHONE/E-MAIL
Address oqA (2e-to"-I Lt( (2c9 u i J�
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: lSeh.���� PHON 96 J � l
5
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed —Y LJI
1981-1991 S t.S L KC-0 Spa or Hot Tub installed Y N
1992-Present
PARCEL.INFORMATION
Topography Flat rolling Steep slope %slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? A-4
Bedrock I Impervious Material At what depth? A/A
Domestic Water Supply x Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: f-.) per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size CA' gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length ZC,P ft.;Each trench S x y
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to abide b these and all equir ents of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: e6c ' �I4/' Date:
Signature: 1 � �_ Date:
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
...Town Df Queensbury Building & Code Enforcement
Office No. (518) 761-8256 — v{Z.
Septic Inspection Report
Inspection request received: It\ 6 4`
Name: CY Inspected on: 10 Ie.I S
Location: 212, Jv keli, 0--- Arrive: , - 14,,,, r 'L •.m.
Permit No.: 110\5 - '2-t ci ��i
Inspector's Initials: _ ,t
C•etS and/or dia•ram
Soil Type r •. lay
Type of Water: •. f ell Water
Waterline separa ion distance ft. ieT
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 Zoo ft.
Length of each trench Mgc5bft.
Depth of trenches -j— 9 ft. k.5' ��b BLIILT
/"
Size of Stone -*N '7_
Seepage Pits: Number
Size: x 1
Stone Size:
Piping Size Type
Building to tank —,"nckk 130
Tank to Distribution Box 1_..y. `Vg—.7' "
Distribution Box to Field/Pit i 1.4.4-l. b'0,-,-25." ' 1.71iN, -77 5-7:g>_.
Opening Sealed:
End Cap _131 -e
r LopQ ‘0,1 \--k.'&;4?..--7) ..--Ci.,-- -
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below gradeN
[provide extension collar if Yes] Ilf'1 N
Location/Separations
Foundation to tank 1' ft.
Foundation to absorption 7:17ft.
Separation of Pits / ft.
Conforms as per Plot Plan ✓Y N
Engineer Report and As-Built Y_N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle R--
System Use Statu .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
0
,eptic Inspection Report
VVilliam Alexander BP 2015=219 .
22 Colonial Court .
Residential Septic Alteration . .
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FILE COPY
SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS ()(
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SUCH AS NOOSES, WELLS, TREES, FENCES, ETC Iza 2
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
,ZJREO THE or N-E SETIRTH ON THIS DIAGUM, i
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BUILDING & •D 4/11 Til"
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Town of Queensbury Building &Code Enforcement
Office No. (518) 761-8256 ,
Septic Inspection Report
Inspection request received: It\
Name: .0-V-Nj.0( Inspected on: to It.I hc
Location: 22-- W &- Arrive: .4�_ ', •.m.
Permit No.: Z0\5 - '2►cj Inspector's Initials: ,tsow
C Arts and/or dia•ram
Or
Soil Type .r •. lay
Type of Water: •. ell Water
Waterline separa ion distance ft. Ov=
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 Zoo ft.
Length of each trench /-ICP ft. ,t '- k-t>b� AS
Depth of trenches - 4 ft. LT
Size of Stone _*7.
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank f s4,1 )`` 1 uD
Tank to Distribution Box 5.9g—-27'
Distribution Box to Field/Pit l l� roVi-2251
5-V
Opening Sealed:
End Cap ✓ N r iACQ o� ll"
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade N
[provide extension collar if Yes] Y N
Location/Separations
Foundation to tank \' ft.
Foundation to absorption
Separation of Pits / ft.
Conforms as per Plot Plan N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle R•-
System Use Statu .
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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William Alexander BP 2015-219
1 22 Colonial Court :
Residential Septic Alteration
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SEPTIC PLOT PLAN
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I HAVE SEEN OR OBSERVED ALL OBJECTS L:3_SUCH AS HOOSES, WELLS, TREES, FENCES, ETC oSHOWN ON TMS DOCUMENT.I HAVE PERSONALLY °
Z.M URED THE pIST E SET RTH ON THIS DIAGRAM.
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William Alexander BP 2015-219
22 Colonial Court
Residential Septic Alteration
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1 I FILE COPY
EPTIC PLOT PLAN
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I HAVE SEEN OR OBSERVED ALL OBJECTS 1:1 2 1.
SUCH AS HOqSES, WELLS, TREES, FENCES, ETC
SHOWN ON TIIIIS DOCUMENT.1 HAVE PERSONALLY•
M a URED THE pIST,,,,E SET IRTH ON THIS DIAGRAM. ,
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SIGNATURE ' DATE ..J._
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BUILDING & fiDr..,4,, Bird
BUILDiNG& CODES "•
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Date: I /Airairi/ '
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