2013-019 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: P20130019 Date Issued: Friday, January 08, 2016
This is to certify that work requested to be done as shown by Permit Number P20130019
has been completed.
Tax Map Number: 523400-288-008-0001-027-000-0000
Location: 83 STATE ROUTE 149
Owner: ELENA RUGGIERO
Applicant: ELENA RUGGIERO
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, 'G+
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
FON 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130019 Application Number: A20130019
Tax Map No: 523400-288-008-0001-027-000-0000
Permission is hereby granted to: ELENA RUGGIERO
For property located at: 83 STATE ROUTE 149
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: ELENA RUGGIERO
57 POPLAR St Septic Alteration Residential
WESTBURY,NY 11590 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
COOKS' SEPTIC
DAN COOK 426-9305
194 HALL HILL Rd
LAKE LUZERNE NY 12846-0000
Plans&Specifications
2013-019
Residential Septic Alteration
$40.00 PERMIT FEE PMD-THIS PERMIT EXPIRES: Thursday,January 23,2014
(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 To f Qu nsbu W• ' 'e70 ay;—January 23,2013— —
SIGNED BY '\ for the Town of Queensbury.
Director of Building&Code Enforcement
~'n Community Development Office JAN 18 2013
1t Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only1{6
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TAX MAP NO. g, g-f--0V)� PERMIT NO. / 3—O 1 q PERMIT FEE
APPROVALS: ZING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFOA ISSUANCE O VA ID PERMIT.
/i'
OWNER: ( (./') RI gt/del, !v{ 1-e7. INSTALLER: ts PIGS ie-
-
ADDRESS: ‘513 I '< y 7 ADDRESS: /7-c( ,4 i/ 641/ i
PHONE NOS. PHONE NOS. (.� . — 250
LOCATION OF INSTALLATION: 50:7 br7
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older 3 X 150 1,21
INSTALLED? I/a
'�'
1981 -1991 X 130 = SPA OR HOT TUB
1992-present JP.\ X 110 = INSTALLED?
PARCEL INFORMATION: /
✓ TOPOGRAPHY: FLAT ROLLI STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
V GROUNDWATER: AT WHAT DEPTH?
V BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
V DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
V 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).
A-4)416.(
- .
TANK SIZE: � GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
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spa or whirlpool tub.
SYSTEM TYPE: CC! -3c I%1 /144,
❑ABSORPTION FIELD (WITH NO.2 STONE) Total length 6-0 ft. Each trench X
oSEEPAGE PIT(S)(WITH NO. 3 STONE) How my? 0/4-- Size?
/
ALTERNATIVE SYSTEM Bed or other type? ��z74-2/747,-/e1,--.5 .----'42
o 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 -•pect t. this application and agree to
abide b - .nd all -. ir- e'is o e Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sani - :ge Di-..os. •rdinacodes(a�queensburv.net
-- '1'7 o s t4i Date VISIT OUR WEBSITE FOR MORE INFORMATION
��+:�• �'e. www.queensbury.net
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection reqAced.
Queensbury Building &Code Enforcement Arrive: '1- 1 t7 4 r /iD---rt: l" 1ari
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials Jf -
NAME: R (.cg /ere) P, •MIT NO.: /3-019
LOCATION: IS 3 'Q 4-c 4' (yq NSPECT ON: /.--13-/3
RECHECK:
Comments and/or diagram
Soil Type San• ..4 :•i"w -y,
Type of Water: Municipal/ ell Wateg--
Waterline separation •istance ft.
Well separation distance lot) ft.
Other wells: 1c)- ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench c • a
Depth of trenches 2 .2-11z—ft.
Size of Stone lag 3 (,, 1 0 + i ?ANT-ay.—,
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank C ic.1 61-/0
Tank to Distribution Box . it ,C i-( Lip
Distribution Box to Field/ Pit r 47/ IA q0 F Q 3(o \ .k L-NV--��Q 2,
Opening Sealed: ___Y_...-N
End Cap ✓'f N
Inlet/Outlet Pipes&Baffles IX
Manholes 12"or less below grade _Y_
[provide extension collar if Yes] _ _ N
Location/ Separations
Foundation to tank ft.
Foundation to absorption 3 ft.
Separation of Pits ft.
Conforms as per P a Y N •
7r
Engineer Report d As-Bu' Y N ��`� ��
ETU Maintenance ntract _Y_ N
provided
Location of System on Property:
Front Rear -' ide Right Side Middle Front Middle Rear
S stem Use Status.
Approved ° Tt 1
Partial Approved and needs to be re-inspected, please call the Building &Codes Dffice
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc
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