2012-177 TOWN OF QUEENSBURY
I
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120177 Date Issued: Wednesday, April 25, 2012
This is to certify that work requested to be done as shown by Permit Number P20120177
has been completed.
Tax Map Number: 523400-315-006-0001-006-000-0000
Location: 690 CORINTH Rd
Owner: KERILIAN, LLC
Applicant: JUSTIN BIZZARO
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 bythe
pp Director of :uilding& Code 'S• ce t
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
41011%
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
EtT
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120177 Application Number: A20120177
Tax Map No: 523400-315-006-0001-006-000-0000
Permission is hereby granted to: JUSTIN BIZZARO
For property located at: 690 CORINTH 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: KERILIAN, LLC Septic Alteration Residential
32 DEVONSHIRE Way Total Value
CLIFTON PARK, NY 12065-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
QUEENSBURY, NEW YORK
Plans&Specifications
2012-177
Res Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 19,2013
(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.)
Dated at the Town nsbury• Thu •I a , April 19, 2012
SIGNED BY `Yfor the Town of Queensbury.
ir
Director of Building& Co'Ent ement
, Revised 4/14/2010
OFFICE USE ONLY
TAX MAP NO._,01 ,�) -/-(, PERMIT NO. PERMIT FEE ��., 1
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: `' °U It IL,
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE].
ISSUANCE OF A VALID PERMIT. BUIL_DING& CODES,
OWNER: DIA Si 1 f\ LSI.11,Of (�_` INSTALLER: It S S egt I( _���
ADDRESS: ��c) ( 1 - \L `�,V • ADDRESS: iil 10 V\Per/uwpU�irf Qn S'�. �.b •( .
PHONE NOS. 2��6�� D C ` n PHONE NOS. p- 0 1 k
LOCATION OF INSTALLATION: M 610 0 l r ni', 1'.(� .
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW •
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = I J INSTALLED?
1981 -1991 X 130 = 1 J SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION: n' '
✓ TOPOGRAPHY: FLAT RO5LING J STEEP SLOPEN %SLOPE\`) (\
✓ SOIL NATURE: SAND JLOAM N l\ CLAY N OTHER
✓ GROUNDWATER: AT WHAT DEPTH? N
-1BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?pl A, \
✓ DOMESTIC WATER SUPLY: MUNICIPAL V , WELL ly I\ (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS \\1 \ PER MIINUTE PER INCH(mph]
(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: 00 C3 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: I i \
o ABSORPTION FIELD(WITH NO.2 STONE) Total length �--p\n' ft. Each trench `T X 5 i
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? `'I V` Size? U
❑ALTERNATIVE SYSTEM Bed or other type? \V )\ \ \r
o HOLDING TANK SYSTEM Total required capacity? `v N Tank size? Iv f-t Number of tanks? (V -
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
Sani`ta S wage Disposal Ordii(nance. codes(a pueensburv•net
�F-� �lp ��(9—(Z VISIT OUR WEBSITE FOR MORE INFORMATION
Signatof P rsoNResponsible Date www.queensburv.net
ure
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
i\I d n a. g ''t o
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: • U
Queensbury Building &Code Enforcement Arrive: am/p Depart: ar ; . /pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: 8 j �� f"v PERMIT NO.: / c•- ---
LOCATION: (p tet'-0 0 .& (- INSPECT ON: i-)—RECHECK:
Comments and/or diagram
Soil Type: ' d Loam / Clay ►,�
Type of Water: l: nic' / Well Water C/ t-r' ' A a S
Waterline separation distance
Well separation distance 4/41 -11I
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench ____e__ft.
Depth of trenches ft. — `t 7C
Size of Stone {- Z`—
—
Seepage Pits: Number )1
Size:
Stone Size:
Piping Size Type
Building to tank Lk~ 51AZ
Tank to Distribution Box
Distribution Box to Field / Pit `` f 12 ^pi
Opening Sealed: /� N
_lir
End Cap si/_N
Inlet/Outlet Pipes &Baffles ✓Y N
Location/ Separations
• Foundation to tank It) ft.
Foundation to absorption 2. ft.
Separation of Pits i—o.1.21 ft.
Conforms as per • •t • •4 ! 7' N
Engineer Report an i As-Buil, Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S -EU - • -.
• Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Buiiding&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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