2013-146 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: P20130146 Date Issued: Monday, April 22, 2013
This is to certify that work requested to be done as shown by Permit Number P20130146
has been completed.
Tax Map Number: 523400-308-012-0002-012-000-0000
Location: 65 MINNESOTA Ave
Owner: GEORGE & PAULA HARRIS JR
Applicant: GEORGE & PAULA HARRIS JR
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 Enfo\•ment
Planning Board or Zoning Board of Appeals.
Oek TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130146 Application Number: A20130146
Tax Map No: 523400-308-012-0002-012-000-0000
Permission is hereby granted to: GEORGE &PAULA HARRIS JR
For property located at: 65 MINNESOTA 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: GEORGE&PAULA HARRIS JR
65 MINNESOTA Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
MCGUIRE. RICK
NY 12804-0000
Plans&Specifications
2013-146
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,April 15,2014
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of e bury; A
,�Monda ,April 15,2013
SIGNED BY /�( for the Town of Queensbury.
Director of Building&Cod nfor merit
'R -\;:, Community Development Office p
'�- :� 1,r, Town of Queensbury •• 742 Bay Road •• Queensbury'N wlYdrk 12804
Office Use Only /1
TAX MAP NO. 3D p O.( - PERMIT NO. 1 ` /1 1 ' PERMIT FEE v' U0
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
/''
OWNER: , CI' HA(/L i 5 INSTALLER: /2.4 elC fi/I L.t
ADDRESS: (VS- i f/ f$ .► 4 &S ,J v�C- ADDRESS: �^,-i//L 0✓' 41 --I 5 7%/-. -
PHONE NOS. 20 _ 5 e/ /r� PHONE NOS. `S-SW' L - 75`6- / -)_o
/1
LOCATION OF INSTALLATION: / c t .-4- 4 if C-
RESIDENCE INFORMATION:
YEAR BUILT
NO. X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = 30 u INSTALLED? /10
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? /U
PARCEL INFORMATION:
✓ TOPOGRAPHYgok.OLLING STEEP SLOPE %SLOPE
✓ SOIL NATUR . SAND V LOAM CLAY OTHER
i GROUNDWATER: AT WHAT DEPTH? 1"-- 4
/ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?_Lifr____
/ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS l-C 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: IlI1rALLON(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:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length W 4- ft. Each trench X
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? / Size? ik)r ' X -2.--Pee I of -CPC"-
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? Iiirnk 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 QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewage Disposal Ordinance. (f / codesOqueensburv,net
J k-X.- VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.clueensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: amm[paa , epart: 4 ` am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ' `1�
NAME: � " '' "L� PERMIT NO.: -2.•L7C?) _ l
LOCATION: ec?`S M-I / - Y INSPECT ON: e{`(c2-y)
RECHECK:
Comments and/or diagram
Soil Type: In Loam/ Clay •
Type of Water: Municipal / Well Water
Waterline separation distance .
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length _ ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number —, �` `
Size: x ZJ4
Stone Size:
Piping Size Type
Building to tank T
Tank to Distribution Box ,,�V c 4,
Distribution Box to Field/ Pit ALL ‘
Opening Sealed: _Y T N
End Cap _ _Y_ N k.)
Inlet/Outlet Pipes&Baffles __.Y N
j
Manholes 12"or less below grade _Y_ N
[provide extension collar if Yes] Y_ N
Location/ Separations
Foundation to tank ft.
Foundation to absorption _ _ft.
Separation of Pits J 2 ft.
Conforms as per Plot Plan _Y_ N
Engineer Report and As-Built _Y_ N_
ETU Maintenance Contract _Y_ N
provided
Location of System roperty:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use Sta- s.
M ppro -•
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 Report03 29 10.doc
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Community Development1Office
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of Queensbury • 742 Bay Rd. TOBUIWLL7N ING G'*UEENSSB. 1r '`
UR
Queensbury, New York •12804 PLOT PLAN Reviewed By: � �3
Date: l��77
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
SIDE PROPERTY LINE
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