2012-234 TOWN OF QUEENSBURY
F
742 Ba•Road, uccnsbur NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120234 Date Issued: Monday, October 21, 2013
This is to certify that work requested to be done as shown by Permit Number P20120234
has been completed.
Tax Map Number: 523400-295-018-0002-005-000-0000
Location: 19 MT. VIEW Ln
Owner: MICHAEL& GWENDOYN CAMERON
Applicant: MICHAEL& GWENDOYN CAMERON
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 by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120234 Application Number: A20120234
Tax Map No: 523400-295-018-0002-005-000-0000
Permission is hereby granted to: MICHAEL& GWENDOYN CAMERON
For property located at: 19 MT. VIEW Ln
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: MICHAEL& GWENDOYN CAMERO
19 MT. VIEW Ln Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2012-234
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, May 11, 2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of eensbury; Friday May 11, 2012
SIGNED BY /1 ` for the Town of Queensbury.
Director of Building&Co. nf.\•ment
Community Development Office '!, : i 1 I.0 I_`_
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only �) �/? a TAX MAP NO._ag6_11$=,--`s PERMIT NO._ ' 3 1 PERMIT FEE (J
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLI ATION IS SUBJECT TO REVIEW FORE ISSUANCE OF A/ALID PERMIT.
OWNER: (- �- Pte_ � 0-c(o •vIINSTALLER: ,/✓ -7/-)'L' ,/ PGv\-tt_ __
/�.1� /
ADDRESS: 1 e Y i____., VL,-c�c..l' ( i-
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ADDRESS: I 2 i —
PHONE NOS. �c ' 7 Q S PHONE NOS. o P-5,)
f -7 9
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GR�I q5
1980 or older X150 = INSTALLED? f"'
1981 -1991 X 130 - _/ SPA OR HOT TUB
1992-present X 110 = INSTALLED? N
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLIN STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND_ LOAMCLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WH7DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL__ (If well:water supply from any septic system absorption is: ft)
I PERCOLATION TEST: RATE IS ___PER MIINUTE 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 lanning Board ap r)ed subdivision).
I;'-js; iJ
TANK SIZE: 1 0(3° 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: Q_o J £
'
❑ ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Eac trench X
SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? 2- Size? "n SI i
❑ 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.
d the regulatio - , • espect to this application and agree to
abid by ese and all re• t a en of the T•. . of Queensbu QUESTIONS? CALL 761-8256 OR EMAIL
Sa 'ary ? age Disp• O nano �� codes(apLL 761 8256 O
—D—ate--5---P.
--- VISIT OUR WEBSITE FOR MORE INFORMATION
g re • Person -espon i•le Date www.queensbury.net
W sclAeacial I-3
Septic Inspection Report
Office No. (518) 761-8256 Date Insioction reque, -i -d
Queensbury Building &Code Enforcement Arrive: 1- a P,0,_••. t hit a pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:: r! -
NAME: .MIT NO.: I a -a 3
LOCATION: a i �-�k-,n U i P_l J /NSPECT ON: 5-/ 16,—/a
RECHECK:
Comments and/or diagram
Soil Type � nam Clay
Type of Water:44141"4., ►� - Water
Watziation distance ft.
We separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches _ft.
Size of Stone ?---N---
rrSeepage Pits: Numberf ' !�Size: x
Stone Size: 2i
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: Y_N
End Cap _ Y N
Inlet/Outlet Pipes&Baffles Y— N
Location/ Separations
• Foundation to tank 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 System of • operty:
Front tr. -.• eft Sid •ight Side Middle Front Middle Rear
S s e Use . ,s:
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 Repottdoc
Septic Inspection Report
1
Office No. (518) 761-8256 Date Insp io r-.u- - iv-,.
Queensbury Building &Code Enforcement Arrive: . I4�'r'► P •part: VY-
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial • `
NAME: C RMNrRJ6R>wTAQ.?.6E� PE' IT NO.: 1 7 — /3E4
LOCATION: Ick S'16vt3TRtrl\\1E-k LtA0 ,I► PECT ON: cc-11—i7
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam / Clay
Type of Water: Municipal / Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO] TOWN OF QUE. '- '',41,
Absorption Field: Total length ft.
Agri
BUILDING & lei '
Length of each trench _ ft. Reviewed B /.1•
Depth of trenches ft. Date: NIM
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type -
Building to tank - ___ -
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: _Y_ N
End Cap _Y_ N
Inlet/Outlet Pipes & Baffles _YN
Manholes 12"or less below grade _Y N _
[provide extension collar if Yes] Y N r 1 C -�fJTi l 1�ijIU��L�
Location / Separations V\ Z , ..__wFoundation to tank ft.
Foundation to absorption ft. y,;
Separation of Pits ft. --Z. �/ -.NcN .'( \
Conforms as per Plot Plan _Y Nt
Engineer Report and As-Built _Y_N �j �'� c
•
ETU Maintenance Contract _Y_ N
provided
Location of System on Property:
Front Rear Left Side ••. t Side Middle Front Middle Rear
System Use Statu
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
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"TOWN OF QUE - - 1-- "I have seen or observed, or believe I saw evidence of,
ail objects such as houses, wells, trees, fences, etc.,
BUILDING & C* i is ! : / shown on this document. il o represent that I have
p , sonally m^ =r the •lances set fsrth on the diagram."
Reviewed By' �r ik
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Date: zi nur/7• .� /
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