2012-095 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120095 Date Issued: Monday, October 21, 2013
This is to certify that work requested to be done as shown by Permit Number P20120095
has been completed.
Tax Map Number: 523400-302-014-0002-082-000-0000
Location: 87 DIXON Rd
Owner: PAUL BRICOCCOLI JR
Applicant: PAUL BRICOCCOLI 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 4 41,5t--
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.
1
00h4 TOWN OF QUEENSBURY
`i 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120095 Application Number: A20120095
Tax Map No: 523400-302-014-0002-082-000-0000
Permission is hereby granted to: PAUL BRICOCCOLI JR
For property located at: 87 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: PAUL BRICOCCOLI JR
87 DIXON Rd Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
SEPTIC ALTERATION
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, March 16, 2013
(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.)
i
Dated at the Town f Que bu 4Fr., . : . • 16 2012
SIGNED BY if • for the Town of Queensbury.
Director of Building&Code Enforcement
ECE " En
Community Development Office
— Town of Queensbury • 742 Bay Road • Queensbury, New York • 2
:Y
Office Use Only TO 1 •
1 BUILDING&CODES
TAX MAP NO. .;DOC.)` 2-ga. PERMIT NO. / oR '-0 `Q� PERMI E
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORORK BEGINS.APPLICATION IS SUBJECT TO REVIEW FORE ISSUANC OF A VALID PERMIT.
OWNER: N�� -SR( L C.J C C J (-___/ TiZ INSTALLER: -/4 i% -Q.C...i u 4/ Q,�2'—'t CL
ADDRESS: d 7 i y 31,-N 1t:) ADDRESS: e 73 V 211,.._ F
PHONE NOS. PHONE NOS. 7 (0- 0 aP c33 '
LOCATION OF INSTALLATION:1 ) 7 .Y, t)„,--) 1`Q
_
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BE ROOMS (Gallons per bedroom) GARBAGE GRIND
1980 or older X 150 = t '�j.) INSTALLED? �
1981 -1991 X 130 = SPA OR HOT TUB !LAD
1992-present X 110 = INSTALLED? 11
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING /'STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPALWELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpg (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 ir4.4 Planning Board approved subdivision).
TANK SIZE: 1 1.---'� _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: -7
ABSORPTION FIELD(WITH NO.2 STONE) Total length Z((0 ft. Each trench 2 X _
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑ 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
a•-.a b, ese and .1, -. irement o he Town of Queens ury QUESTIONS? CALL 761-8256 OR EMAIL
anit. wage D: os j Ordin.:/• codesna queensbur '.net
I - to l VISIT OUR WEBSITE FOR MORE INFORMATION
Si. a re of Person •onsible D www.queensbury.net
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ m Depart:II,'C am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials
NAME: F c r er)CO c)/ PERMIT NO.: /�( —o q 5-
LOCATION: T_7 1' <_-)c) Rof INSPECT ON: .3-lc, - 1,;\RECHECK: x
Comments and/or diagram
Soil Type: 410 1_0/ Clay
Type of Water: Municipal/ Well Water 1
Waterline separation distance -ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
Absorption Field: Total length 'Z. L) ft.
Length of each trench Ti _t ft.
Depth of trenches ' t- �`` ft-
Size of Stone "'L..
Seepage Pits: Number pjlipt----
Size: x
Stone Size:
Piping Size Type _
Building to tank C �'`� `
Tank to Distribution Box 4" Q .31
Distribution Box to Field/ Pit '` 7?_1.23 h
Opening Sealed: ' Y N
End Cap ✓Y TN
Inlet/Outlet Pipes& Baffles T Y N
Location/ Separations
• Foundation to tank , - lS-`^Z4 'r�.
Foundation to absorption el—,1 ft.
Separation of Pits ki 14— ft.
Conforms as pe P a _ N
Engineer Report(id As-6ui1 ' Y N
Location of Systet' a I Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S -I Us- ._ , :
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