2015-116 TOWN OF QUEENSBURY
Iwo742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150116 Date Issued: Wednesday, April 29, 2015
This is to certify that work requested to be done as shown by Permit Number P20150116
has been completed.
Tax Map Number: 523400-301-007-0001-007-000-0000
Location: 13 CENTENNIAL Dr
Owner: RICHARD & KIM ROBERTS JR
Applicant: RICHARD & KIM ROBERTS 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 ( 4°1
)0t--
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.
064
TOWN OF QUEENSBURY
woo 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150116 Application Number: A20150116
Tax Map No: 523400-301-007-0001-007-000-0000
Permission is hereby granted to: RICHARD & KIM ROBERTS JR
For property located at: 13 CENTENNIAL 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: RICHARD & KIM ROBERTS JR
13 CENTENNIAL Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
OUEENSBURY,NEW YORK
Plans&Specifications
BP 2015-116
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,April 27,2016
(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 ex iration date.)
Dated at the Tow of Qu sb , pril 27,2015
SIGNED BY \ for the Town of Queensbury.
Director of Building& Code Enforcement
•
VECEOW EnA—pR 2 4 2015 3617-I -7
Revised 4/14/2010
OFFICE USE OOF -+ E�ISBURY
TOWN 9F—
I 11, LW (r
TAX MAP NO. -
BUILD' PERMIT NO. Ii 'PERMIT FEE
APPROVALS: ZONING TOWN CLERK
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: I LL UI rd 1Q\O 4'C (4 INSTALLER: 16 S 5 ^-e �) C
ADDRESS: 1-3 (�' '� T
�r ?'n t tA, Or, ADDRESS: /, I aw-�r U W/ I !t''QrN,_5 i •
PHONE NOS. 1 9 - 0 C4 PHONE NOS. 1 1 p 1 9Y
LOCATION OF INSTALLATION: n(i'dl'"\-Pry+(A` 0 r
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRIND
F�
1980 or older X 150 = I-}-c() INSTALLED? �
1981 -1991 X 130 = SPA OR HOT TUR(,
1992-present X 110 = I INSTALLED? )V�}
PARCEL INFORMATION:
•
✓ TOPOGRAPHY: FLAT ROLLINGI STEEP 1 SLOPE n %SLOPE Iv F1
✓ SOIL NATURE: SAND LOAM Ill 1\ CLAY N) OTHER \V
A
✓ GROUNDWATER: AT WHAT DEPTH? w \r i
V BEDROCK/IMPERVIOUS MATERIAL: AT WHAT EPTH? 1"
✓ DOMESTIC WATER SUPLY: MUNICIPAL ,AT_
\\ (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS V PER MIINUTE PER INCH[mpiJ
(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: I C'C t 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 TATE:
ABSORPTION FIELD(WITH NO.2 STONE) Total length loo ft. Each trench X 5 0
1 '
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? IIVI((gyp I
Size? V 1'r
❑ALTERNATIVE SYSTEM Bed or other type? I v I�
�, r \ n
0 HOLDING TANK SYSTEM Total required capacity? I�/ i Tank size? 1V)� . Number of tanks? IVr
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
Sanitary Sewa• iv .•:- • finance. cades(a�queensburv.net
I 2qiIj VISIT OUR WEBSITE FOR MORE INFORMATION
Sig • • P- ry:•n Responsible Date www•aueensbury.ne#
Town of Queensbury* Community Development Office* 742 Bay Road, Queensbury NY 12804
2
Town of Queensbury Building &Code Enforcement v S �' c h --
-Office No. (518) 761-8256 I -
Septic Inspection Report
Inspection request received: _ l / -7/( S-
Name: P-013-e,) #S Inspected on:
Location: f C-e-m.( C L - Arrive: a.m./p.m.
Permit No.: lc /(( Inspector's Initials:
Comments and/or diagram
Soil Type: And oam/Clay
Type of Wa er• u .cipal ell Water
Waterline separ ion distance ft.
Wet separation distance ft
Other wells:
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length 20-C>ft.
Length of each trench ft.
Depth of trenches 3-' ft.
Size of Stone
Seepage Pits: Number
Size: (x
Stone Size: 11(
Piping Size Type
Building to tank ---- \,-,, Z61-(izt•
Tank to Distribution Box
Distribution Box to Field/Pit 4
Opening Sealed: Y, !T N
End Cap AN
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 J' ft. ---"F*L5,$'q*(ej
Foundation to absorption ft.
Separation of Pits
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 ' ..r Left Side Right Side Middle Front Middle Rear
S stem Use St.s.. • MOW
./ Appro -.
artial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
C.
SHOWN ON THIS DOCUMENT I HAVE PERSONALLY ;
R,1L;SUR i T• DI A CE SET FORTH ON TIS DI GRAM.
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