2012-221 TOWN OFQ UEENSBURY
F.44 gra
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120221 Date Issued: Wednesday, May 09, 2012
This is to certify that work requested to be done as shown by Permit Number P20120221
has been completed.
Tax Map Number: 523400-301-012-0001-019-000-0000
Location: 18 HELEN Dr
Owner: JOSEPH& ELENA SCRIVO
Applicant: JOSEPH& ELENA SCRIVO
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 J.
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
O.` TOWN OF QUEENSBURY
..4 .
742 Bay Road,Queensbury,NY 1280.4-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120221 Application Number: A20120221
Tax Map No: 523400-301-012-0001-019-000-0000
Permission is hereby granted to: JOSEPH&ELENA SCRIVO
For property located at 18 HELEN 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: JOSEPH&ELENA SCRIVO Septic Alteration Residential
18 HELEN Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2012-221
septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,May 07, 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 ue sbuty ,,"1° y ay 07,2012
SIGNED BY / for the Town of Queensbury.
Director of Building&Code Enforcement
ii----
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r--- __ JRevised 1 0 0
OFFICE USE ONLY I1 I —7
a)i. 1)-i-0 / u`' f MAY f) 2012
TAX MAP NO. PERMIT NO. dt—CU) PERMIT FEE
APPROVALS: ZONING TOWN CLERK
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APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: .---- L'J =a
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCEO A VALID PERMIT.
OWNER: JOS Ser' n S G rI JO INSTALLER:
ADDRESS: S^ H 1., It'^01 ' ADDRESS: 1 L()'W e WUr c . , S4, 0 k-
1
PHONE NOS. --:) )-----Ln l' 0 0 PHONE NOS. 1 C — 1
LOCATION OF INSTALLATION: 71 %13e\ir' Of.
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X (Gallons per bedroom) = TOTAL DAILY FLOW GARBAGE GRI %R
1980 or older IV N. X 150 = 1 V N INSTALLED?
1981-1991 - X 130 = Y /° SPA OR HOT TU ,fl
1992-present IV X 110 = N t� _ INSTALLED? 11
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLL G I STEEP�)SLOPE�Vf,k %SLOPE\1 l
V
✓ SOIL NATURE: SAND L(O�AM 1`/ I t' CLA'�I! Pc OTHER\I N.
✓ GROUNDWATER: AT WHAT DEPTH? I
I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? rN lk
I DOMESTIC WATER SUPLY: MUNICIPAL V WELLt\V i(If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS \\I 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: l[ n GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
e..140x) each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE: L
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length 1(1Q ft. Each trench t \I 1 X0
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? 1 Iv t k Size? \\I k
ID ALTERNATIVE SYSTEM Bed or other type?
\ p I
IDHOLDING TANK SYSTEM Total required capacity? \v' lT Tank size? \\I i\ Number of tanks? [V 1k
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
Sanita ewage Disposal Ordinance. codos(a�uueensburv.net
,flJ VISIT OUR WEBSITE FOR MORE INFORMATION
Signature o Pe on esponsible Date www.queensbury.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
A 1"rl
Septic Inspection Report I +`
Office No. (518) 761-8256 Date Inspection request received: 2U/ 3---
Queensbury
Queensbury Building&Code Enforcement Arrive: am/gym Depart: A am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: /` K
NAME: J �/l L� C T t LJC PERMIT NO.: -a a I
LOCATION: 1 �e-v\ T�4r INSPECT ON: ' ;.,. 17'
.. _ ry
RECHECK: �• ��
Comments and/or diagram
Soil Type:(a / l(6aJ) Clay
Type of Water: Cuipal Well Water
Waterline separation distance A ►
Well separation distance AUG ft.
Other wells:
Well Casing Length 50' +/ - Y N
[150'to well required if NO]
Absorption Field: Total length '2- ft.
Length of each trench ft.
Depth of trenches '1L. ft.
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type ) � / 07323 �4-{,_1-)A-14 j-cs,
Building to tank --'----
Tank to Distribution Box L�`` s�,��E-Z�
Distribution Box to Field/ Pit 4 ' �C.1,�r2ry FFaL2az
Opening Sealed: . N
End Cap N
Inlet/Outlet Pipes&Baffles VY
Manholes 12"or less below grade Y N� -
[provide extension collar if Yes] Y N/14-
Location/ Separations
Foundation to tank 0-4" ft.
Foundation to absorption '1-2- ft.
Separation of Pits • JA-ft.
Conforms as per Plot-Pfau. �/� N
Engineer Report an As-Buull VY ---N
ETU Maintenance Cartrfact Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use Statu
/Approve.
•_ - . pproved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Fonns\Inspectlon Fomts\5eptic Inspection Report_03 29 10.doc
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