2012-398 TOWN OF QUEENSBURY
wow 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120398 Date Issued: Thursday, October 10, 2013
This is to certify that work requested to be done as shown by Permit Number P20120398
has been completed.
Tax Map Number: 523400-302-005-0001-003-000-0000
Location: 448 AVIATION Rd
Owner: CHURCH OF OUR LADY OF ANNUNCIATION
Applicant: CHURCH OF OUR LADY OF ANNUNCIATION
This structure may be occupied as a:
Septic Alteration Commercial
S c- e �' r ott'-1, ChareA\ By der FoTown Board
v / TOWWN OFTown
LLL
Issuance of this Certificate of Compliance DOES NOT relieve the C7 _���k 4E ' '(/
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
(Et 742 Bay Rend,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120398 Application Number: A20120398
Tax Map No: 523400-302-005-0001-003-000-0000
Permission is hereby granted to: CHURCH OF OUR LADY OF ANNUNCIATION
For property located at: 448 AVIATION 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. Tette of Construction Value
Owner Address: CHURCH OF OUR LADY OF ANNL
Septic Alteration Commercial
448 AVIATION Rd
QUEENSBURY,NY 12804 Total value
Contractor or Builder s Name/address Electrical Inspection Agency
CHARLES FRIEDMAN
54 NORTH St
HUDSON FALLS,NY 12839-0000
Plans&Specifications
2012-398
Commercial Septic Alteration- Front of Church, Site A
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 16,2013
(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 Queensbury; Thursday,August 16,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
L CL, k y tv Liz u
Community Development Office-
pn
Town of Queensbury • 742 Bay Road • Queensbury, New York �•12804 15 2012
I
i I
Office Use Only 6 TOW i"— 'I---�R
�SUr�Y
2 3 I PERMIT EEE'3UILO. ,', CODES
TAX MAP NO. �3D a, 5-�' PERMIT NO. � -�3 ( Q ��.`
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS./ APPLICATIONI/�7IS SUBJECT TO REVIEW BEFORE��f/ ISSUANCE OF A VALID PERMIT.cc
OWNER G//Oft LAQ off/e.._4FAOUCk(/OSTALLER. (XM/ck r/e -ed-n w SYc
ADDRESS:1/ AOIA/
A/ D/Li€oq §� ADDRESS: J c/rte-it iot-Hi s rr- /Yi tI sc tJ FAT
PHONE NOS 5/J7 7C/; - /4-7-7 PHONE NOS7C/7
X7•- C A l 37/
LOCATION OF INSTALLATION: f/CoiO ( .K¢-ck a J r 14 v/2-!1 4
// RESIDENCE INFORMATION:
I NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRIND hh
1980 or older X 150 = INSTALLED? /�
1981-1991 X 130 = SPA OR HOT TUBE A
1992-present X 110 = INSTALLED? //
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE °/SLOPE
I SOIL NATURE: SAND LOAM CLAY OTHER
I GROUNDWATER AT WHAT DEPTH?
/ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:waters ly ny�ptic system absorption is: ft)
I PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[moil (Test Wal ted 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: GALLON(MIN.S11S 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa oT MwTYPE:Aool tub. 7 / � k -
FV_IN 3T OE ��
SYSTEM J LJY�1 1
D ABSORPTION FIELD(WITH NO.2 STONZot- ✓- ,1 ft. Each trench X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) Ho man Size?
0 ALTERNATIVE SYSTEM Bed or other type?
0 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 C
1-8256 OR EMAIL
Sanitary is sal Ordinance. sburv.net
/ /)- MORE INFORMATION
Signature of Person esponslSle e
tiumnet
s-Ctt-v us
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req y:1: rt�
Queensbury Building &Code Enforcement Arrive: 1=h7) a / '*`'part: V .-U: a
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: .• Na: 01".396
/ - INSPECT ON: F —1D-`t7
LOCATION: '��/ Zr � i �n
RECHECK:
Fr/749 editi.lotejh) Comments and/or diaoram
Soil Type: Sand/ Loam/ Clay � - Ito-13
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]
Absorption Reid: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x —
Stone Size:
Piping Size Type ��\ ,
Building to tank
Tank to Distribution Box tDistribution Box to Field/ Pit e.S7
Opening Sealed: Y—N ,
End Cap Y —N l�
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade ._Y N
[provide extension collar if Yes) —Y—N
Location/ Separations
Foundation to tank _ ft.
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan — N
Engineer Report and As-Built Y—N
ETU Maintenance Contract _Y_N
provided
Location of System on Property:
Front r Left Side Right Side Middle Front Middle Rear
S em S
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\In on Forms\mac Ikon Repo&03 29 10.doc
2- IAA-
Septic Inspection Re 12
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Office No. (518)761-8256 Date Inspectio2req ts part; � 7pmQueensbury Building &Code Enforcement Arrive: i"h`6 a'
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials
NAME:
GPI VITACr-G✓( I A(-/ aC n P1-44,-)C-.1 AI ci.. • :• IT NO.: la -39
LOCATION: Y Lis '
, t -t- i ti4
� �� SPECT ON: 5/1-;11 I
RECHECK:
Comments and/or diaoram
Soil Ty•. i, •- Clay HJRC SAS-Vet-kJ
Type of Water 4.9! „.;" • - Water
Wate ration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y_N_N/A
[150'to well required if NO]
Abso ' F Id: Tota - , •
gth ., -r.ch ••- /7 ft-
iepth of ( ft. 0---
5eterilliAM:.
• e • Stone,.rL 1
Size: _MI x ueFtc, - V'S=\J5 w
Stone Size: Z &tb' ItTrc.4--
Piping Size ‘T--We
F ` ' L
Building to tank 1`l.i� � /0% �+� T� ��.
OtAV Two Distribution Box `�y E-ti tS-- M��C�� t,tL !C�k�D
Distribution Box to Field/ Pit N 4
Opening Sealed:
End Cap E1��6 ASE w�PE�
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade —N
[provide extension collar if Yes] _Y N t\ink C7\3 y�17 .C .\
Location/ Separations [ t�� �(�
Foundation to tank ewhT_ ft.
Foundation to absorption ft.
Separation of Pits —�!� `��`� C:=
- CC� �
Conforms as per Plot Plan Yy- 5/
Cl
Engineer Report and As-Built —Y
ETU Maintenance Contract _Y—N ,.D
provided — N �at> ,�C i � �l� p'
Location of System on Property:
Front R r Left Side Right Side Middle Front Middle Rear
S em Use Sta s: �---3-6:-- i- ---i-1 F bet-7-t�'-
Approved
Partial Approved and needs to be re-inspected, please call the Builth g&Codes Office
Disapproved
L:\Pam Whiting\2010\Buildin9 Codes Forms\lrkW&tlon ForrnS\mac Inspection Rep0rt...SG 2910.doc
MAP REFERENCE:
MAP OF LANDS OF
CHURCH OF OUR LADY
OF THE ANNUNCIATION
DATED: DECEMBER 28, 1979
BY: COULTER & McCORMACK
LANDS N/F OF
CATHERINE KEENAN
14631156
m �
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Q 4
LEGEND: LL W
W O
i O CIRF = CAPPED IRON ROD FOUND
o CM = CONCRETE MONUMENT FOUND W
`qO_, = UTILITY POLE co
® = TRAFFIC SIGNAL POLE
= METAL FENCE LINE
= EDGE OF WOODS CV w
== MANHOLE
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DECIDUOUS TREE
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CONC E
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EXISTING K
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5EPrIc TANK
NEW 29X 30' U N
` �.,� s "x +1•",+N AB50RFTION BEDS
NOTE: PEKORATED PIPES UN)
OUT
DI5RIBSED
OF DISTUTION BOXES NEW 5'0 DUPLEX
PUMP
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