2012-193 TOWN OF QUEENSBURY
g742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120193 Date Issued: Tuesday, May 01, 2012
This is to certify that work requested to be done as shown by Permit Number P20120193
has been completed.
Tax Map Number: 523400-239-008-0001-029-000-0000
Location: 40 BOATHOUSE Rd
Owner: WILLIAM & LYNNE MASON
Applicant: WILLIAM & LYNNE MASON
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 f f
property owner of the responsibility for compliance with Site Plan, id
Variance, or other issues and conditions as a result of approvals by the AVL
Director of Building&Code Enforcemen
Planning Board or Zoning Board of Appeals.
064 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120193 Application Number: A20120193
Tax Map No: 523400-239-008-0001-029-000-0000
Permission is hereby granted to: WILLIAM&LYNNE MASON
For property located at: 40 BOATHOUSE 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: WILLIAM &LYNNE MASON
P.O. BOX 85 Septic Alteration Residential
CLEVERDALE,NY 12820-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2012-
res. septic alteration
750 gal metal tank to be replaced with 1,000 gal concrete tank
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,April 25,2013
(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 Towrkof Qu nsbu.,+ W j. e/i a April 25, 2012
SIGNED BY - 4� for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010 ---,1,
OFFICE USE ONLYI ! .
4:. et_ i iTAX MAP NO.p36i..11 7 PERMIT NO. )D- /q.-3 PERMIT FEE i 4 �/ An„ V 1 2012
APPROVALS: ZONING TOWN CLERK V
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: .i-- "'bbuRY
i FUILD NG &CODES
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE!id/
A VALID PERMIT. -779XK/V D.E 41O r G r7T G/ZJ'. /J4
OWNER: !N/L(-1 A n ,'7f9-S0 e.) INSTALLER: /
ADDRESS: 91.) ,67J/9 j"--/J ' S/-- 2Q, ADDRESS: t) if On T))' 'ces .'Z12
C._,..- . t/ KPi? e-4 rt)/ i2S'-1-0 G �E V-_'_ .c +%'Ia ��i Ay / —. '
PHONE NOS. f" v L - (o O,3 PHONE NOS.
LOCATION OF INSTALLATION: Yu ✓ n pit,,e__52- , / G L ,,/,--,<D4 L E / /./7 -tS '
RESIDENCE'INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older —g X 150 = 44.1—v INSTALLED? /LJ 0
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? U
77-//5 .5y5rEr'1 5,-6',1-1,V65- ort L / 3 �6D1 co,--,s 2 45/-THiLaor7-5
PARCEL INFORMATION: /," -5C)t-I . :11 ,E r1p In,,c Ho�.( S .
,1TOPOGRAPHY: FLAT ROLLING >e STEEP SLOPE p %SLOPE ( 5�1`',41413 r - S ST.(/h in)
/1v�TN faf<', 1•l/rcJH�/J�
✓ SOIL NATURE: SAND LOAM X CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? "'
I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? y T
✓ DOMESTIC WATER SUPLY: MUNICIPAL X WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MINUTE PER INCH[mpi]
(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: /a 0 O 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. o G L ,,�cryATF T13r'1�
4-//e, /gee -7 5-e..) /67,3L ✓Ike 71 /
SYSTEM TYPE:
['ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
o 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 abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sew ge" Disposal Ordinance. codes(&queensburv.net
(�C Lam— ���r� / 2.--
i
/ VISIT OUR WEBSITE FOR MORE INFORMATION
i nature of Person Responsible [31ate
/ www.queensburv.net
9 P
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
[\{\,(0 f\act.6 (31;
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm epa rtr2{ am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: .4 °2
NAME: WI 3.40 PERMIT NO.: / oZ -/(4 3
LOCATION: 410 ?)G4—h b C�S' INSPECT ON: 41-3(7-14
RECHECK:
Comments and/or diagram
Soil Type: Sand / oam / lay
Type of Water: Municipal Well Wa,-r
Waterline separ. ion distanc: U ft.
Well separ-tion distance ft.
Other wells: ft.
Well Casing Lengt. 50' + / - Y N N/A
Absorption Field: otal length ft.
Length of ch trench ft.
Depth o trenches ft.
Size f Stone
( ccs
Seepage Pits: umber
�
/•
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y_N
End Cap71 N
Inlet/Outlet Pipes & Baffles Y— N
Location/ Separations
• Foundation to tank "2--E-1— ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built _Y N
Location of - -m on Property:
Front •ear Left Side Right Side Middle Front Middle Rear
System Use Sta .
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
...., Community!Development Office
Town of Queensbury • 742 Bay Rd. r
Queensbury, New York •12804 PLOT PLAN PILE (_j
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APR 2 4 2012
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