2012-329 011111W TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120329 Date Issued: Tuesday, July 10, 2012
This is to certify that work requested to be done as shown by Permit Number P20120329
has been completed.
Tax Map Number: 523400-315-006-0002-055-000-0000
Location: 9 GOLDFINCH Rd
Owner: JOSEPH & MARY K. LALUNA
Applicant: JOSEPH & MARY K. LALUNA
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 nforc‘.1 ent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
aP
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120329 Application Number: A20120329
Tax Map No: 523400-315-006-0002-055-000-0000
Permission is hereby granted to: JOSEPH &MARY K. LALUNA
For property located at: 9 GOLDFINCH 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: JOSEPH &MARY K. LALUNA
9 GOLDFINCH Rd Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
QUEENSBURY,NEW YORK
Plans&Specifications
2012-329
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 09,2013
(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 o Quee ury; fMo s;,: A :9,2012
SIGNED BY V \ for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office JUL 06 2012
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only `` __ _
TAX MAP NO. J 1I 5 ,LQ 55 PERMIT NO. 1 -3 a9
PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.J
OWNER: OC L (U,. .. 0 INSTALLER: 1.6'
ADDRESS: *9- UV` 1 1 r�i.AL ADDRESS: 1-Lc)vverWG f r Qr`Ji.
0PHONE NOS. 3b1'09 PHONE NOS. —14 - L1 1 9 Lk
LOCATION OF INSTALLATION: t\` Q (! Vnl J-E(v,L,
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present .3 X 110 = 3 'V\ INSTALLED?
PARCEL INFORMATION: `j �r 0
✓ TOPOGRAPHY: FLAT ROFING `�' STEEP SLOPE 111ik' %SLOPE I y\r
✓ SOIL NATURE: SAND \/ LOAM K4 CLAY N N OTHER I V I�
✓ GROUNDWATER: AT WHAT DEPTH? \J 1\
/ BEDROCK/IMPERVIOUS MATERIAL: AT WH DEPTH? I Y
/ DOMESTIC WATER SUPLY: MUNICIPAL \WELL N I\(If well:water supply from any septic system absorption is: ,\J 1\ft)
✓ PERCOLATION TEST: RATE IS IV IV 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 Planning Board approved subdivision).
TANK SIZE: 1 P Dc 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.(':I 3'f )
SYSTEM TY/PE: n
ri ABSORPTION FIELD(WITH NO.2 STONE) Total length ��Dn ft. Each trench `( X L 0
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? ` r(V N. Size? \1J Pr
❑ALTERNATIVE SYSTEM Bed or other type? I `1 fr ,r
0 HOLDING TANK SYSTEM Total required capacity? �\/ r Tank size? IV 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
S ita ag gispos dinance. -)-6-I codes(a�queensbury.net
Signature of Per�on�te ponsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection requ--. _.
Queensbury Building &Code Enforcement Arrive: ;DD a jpm a
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials Mile
NAME: e_ AL 1_,Lt✓1�- P •MIT NO.: / � 3
LOCATION: 9 A- l c-L It✓►r.)h SPECT ON: '?
RECHECK:
Comments and/or diagram
Soil Ty•e: sla oam / Clay
Type of Water: 'unici•. Well-Water 0.)(\.N .LL-).Waterli - --•aration distance
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length u ft.
Length of each trench ti ft.
Depth of trenches "-7g ft.
Size of Stone ,
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank ! [-H Lie.) EX-11 T\ ;,O)
Tank to Distribution Box t•--f" V(i
Distribution Box to Field/ Pit / \wr Qa,Qu._,�
Opening Sealed: ,.. N
End Cap
Inlet/Outlet Pipes &Baffles Y T N
Location/ Separations•
Foundation to tank f.a. perr AS B U tL I
Foundation to absorption ft.
Separation of Pi / ft.
Conforms as per PI an i/ T N
Engineer Report a As-Buil, Y N
Location of System on Property:
Front( Rear -ft Side Right Sid- Middle Front Middle Rear
-• 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 Report.doc
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