2012-348 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120348 Date Issued: Monday, October 21, 2013
This is to certify that work requested to be done as shown by Permit Number P20120348
has been completed.
Tax Map Number: 523400-302-014-0002-051-000-0000
Location: 3 BULLARD Ave
Owner: KATHLEEN GAISER
Applicant: KATHLEEN GAISER
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,
(--cDavP
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code, forcemeat
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120348 Application Number: A20120348
Tax Map No: 523400-302-014-0002-051-000-0000
Permission is hereby granted to: KATHLEEN GAISER
For property located at: 3 BULLARD Ave
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: KATHLEEN GAISER Septic Alteration Residential
3 BULLARD Ave Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2012-348
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 24,2013
(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 Bens ry; sda J,y 24, 2012
7
r for the Town of Queensbury.
SIGNED BY Q ur}
Director of Building&Code Enforcement
t
C
I'W Community Development Office JUL 2 2012
v-,-to Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only 2 c� --
-
TAX MAP NO.�0�(, IN `�ay51 PERMIT NO. 1),- 39O PERMITFEE_I°�/
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM P RMIT: A PERMIT MUST E OBTAINED
BEFORE WORK /BE/GINS.. A_PIPLICATION IS SUBJECT TO REVIEW ORE ISSUANCE A VALI PERMIT.
OWNER: K, ( C .liQ ems} (to Or(d'/�'' INSTALLER: �jG j_itt7 Q(V,; <P-14 C C_
ADDRESS:_i____aADDRESS: O 1S u(� G2 6
PHONE NOS. PNOON NOS. 79 Ip - 0 ,
LOCATION OF INSTALLATION: 2, ?;IIti U(J v' ,
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BE ROOMS_ (Gallons per bedroom) GARBAGE GRI
1980 or older X 150 = 4/6--o INSTALLED?
1981-1991 X 130 = SPA OR HOT TUBo
1992-present X 110 = INSTALLED? 1
PARCEL INFORMATION: �/
✓ TOPOGRAPHY: FLAT ROLLI - STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WI-I DEPTH? _
I DOMESTIC WATER SUPLY: MUNICIPAL �/ WELL (If well:water supply from any septic system absorption is:, ft)
✓ 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 Planning Board approved subdivision).
TANK SIZE:(003 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 �An
SYSTEM TYPE: � lute kc 1 cJ C It r------
0 A) Cy
❑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?
❑ 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 regu .;Ins with respect to this application and agree to
abi these a .•al :e uireme of the Town of ueensbury QUESTIONS? CALL 761-8256 OR EMAIL
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nit Sewa. ir . -:IOr.'e/ce. codesAqueensburv.net
- "/- '/ --- vj l VISIT OUR WEBSITE FOR MORE INFORMATION
gn.,ure o •ers. 'esponsible ate
www.queensbury.net
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/•m -•art: '=gym/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: •
NAME: r [ SC? r PERMIT NO.:
LOCATION: .3 u i t(“-d. 4 0 P INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: = , Loam/ Clay
Type of Water: f t: / Well Water
Waterline separation distance I ft.
Well separation distance .
Other wells: r -N ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft. OLAA- 1\1\4+3\--
Length of each trench ft.
Depth of trenches ft.
Size of Stone L.77-5°
Seepage Pits: Number
Size: x
Stone Size: - _
Piping Size Type
Building to tank Ac - O
Tank to Distribution Box1747
Distribution Box to Field/ Pit � N
Opening Sealed: Y N
End Cap _N
Inlet/Outlet Pipes &Baffles Y N
Location/ Separations
• Foundation to tank (7- 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 on Property:
Front R-ar Left Side Right Side Middle Front Middle Rear
S . Us- .1 _
Approved
Pa la 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 Reportdoc
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Community Development Office
_ _ Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
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