2013-133 TOWN OF QUEENSBURY
*MI742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20130133 Application Number: A20130133
Tax Map No: 523400-303-008-0001-007-000-0000
Permission is hereby granted to: ANDREW ALLISON
For property located at 262 QUEENSBURY 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: ANDREW ALLISON
LAURA CARUSONE-ALLISON Septic Alteration Residential
262 QUEENSBURY Ave Total value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
CUTTING EDGE GROUP. LLC
14 WALKUP CUTOFF Rd
LAKE GEORGE.NY 12845-0000
Plans&Specifications
2013-133
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,April 08,2014
(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 Quee bu AMo . i y/A i : 08,2013
4
/vl
SIGNED BY I- \ for the Town of Queensbury.
Director of Building&Code Enforcement
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: P20130133 Date Issued: Thursday, June 20, 2013
This is to certify that work requested to be done as shown by Permit Number P20130133
has been completed.
Tax Map Number: 523400-303-008-0001-007-000-0000
Location: 262 QUEENSBURY Ave •
Owner: ANDREW ALLISON
Applicant: ANDREW ALLISON
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 < \) A
property owner of the responsibility for compliance with Site Plan, //) (i/
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code orce`t nt
Planning Board or Zoning Board of Appeals.
For an EPA homeowner's guide: http://www.epa goy/nodes/pubs/homeowner guide long customize.pdf
r� OFFICE USE ONLY
34 (�
TAX MAP N3 , % + / PERMIT NO.( 3 " 'S&ERMIT FEE (ID CAD Date
APPROVALS: ZONING TOWN CLERK Arn 1C/A1- 2013
.7
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. �1 / jr
OWNER: 4 9j`73&41 r 5Di /j INSTALLER: 4/r-,finch '..{�4.6 62440
g�
ADDRESS: , Z&U)9 'ac eer ADDRESS. �°a" 0 m6 O `," i� 74.91". t,on
PHONE NOS. 5,/7J ender Mani stSee-
S f1 ,T PHONE NOS. 79d- 9,J� l c %c.
LOCATION OF INSTALLATION. Alga 0aithair/
RESIDENCE
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
BEDROOMS
1980 or older X 150 gallon per bedroom = 0 GARBAGE GRI D'ER
INSTALLED? Nb
1981 -1991 3 X 130 gallon per bedroom = efQ
1992-present _ X 110 gallon per bedroom = 0 SPA OR HOT Til b
INSTALLED? (�
PARCEL INFORMATION: .
✓ TOPOGRAPHY: FLAT ROLLING )<- STEEP SLOPE SLOPE %
✓ SOIL NATURE: SAND LOAM X CLAY OTHER //
✓ GROUNDWATER. AT WHAT DEPTH? /IA BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? /YA/
✓ DOMESTIC WATER SUPLY
MUNICIPAL )C WELL (If well:water supply from any septic system absorption is:f ft)
✓ PERCOLATION TEST: RATE IS •/FJ PER MIINUTE PER INCH(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: 22-60)
,
l/7i 0) 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.
SYSTEM TYPE:
:ABSORPTION FIELD (WITH NO. 2 STONE) Total length r '4 ft. Each trench / X
❑SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
ALTERNATIVE SYSTEM Bed or other type?_ T rAvE . • Ia✓ . - 6P
❑HOLDING TANK SYSTEM Total required capacity? Tank size? Number of to s?
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 QUESTIONS? CALL 761-8256 OR EMAIL
to abide by these and all requirements of the Town of Queensbury codes@4ueensburv.net
Sanitary Sewage Disposal Ordinance. VISIT OUR WEBSITE FOR MORE INFORMATION
www.4ueensburv.net
Signature erson Responsible Date
aTown of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
m .01-n3
10
Septic Inspecction Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/p Depart: '�7 f dam/pm
742 Bay Rd., Queensbury,nnNY 12804 Inspector's Initials:(,1 3 2 \
NAME:. �'f i i � PERMIT NO.: I3-/-33
LOCATION: J t� ( U CCAS � ..tr-y j'Je' INSPECT ON: Lo—I6 "-I3
RECHECK: Q
Comments and/or diaoram
Soil Type: Sand/ Oa
Type of Water: MunicipalfWell ater C 53 ' 4.16-9g
Waterline separation'$istance / ft A-na _ r&D rnd'
Well separation distan / ft.
I Other well . ft.
Well Casing Length 50' + - Y N_N/A
[150'to well required if O]
Absorption Field: Total ngth\ ft.
Length of ea trench \ ft.
Ddpth trenches \ ft
• e of Stone \
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type )_
Building to tank It
Tank to Distribution Box ,tet tp T�`c' G)
Distribution Box to Field/ Pit _L C
Opening Sealed: Y N
End CapN
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] _Y_ N 1 ,,1 [, q ,, gatiL4tU S
Location/ Separations � ' v—'
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Piot Plan _Y_N
Engineer Report and As-Built _Y N
ETU Maintenance Contract _Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use Statu
A
artiai Ap ed and needs to be re-inspected, please call the Building &Codes Office
D ed
L:\Pam Whiting\2010\&jilding Codes Forms\Unspedtlon Forms\Septic Limon Report_03 29 10.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: 17 A9 13
Queensbury Building&Code Enforcement Arrive: am/pm Depart: ti am/pm
742 Bay Rd., Queensbury,'yNY 12804ppInspector's Initials: f 3
NAME: �t^o Aai ISo,., NO.: Mt - 0t 33
LOCATION: d-(02 �St-% Avg. INSPECT ON: 10106013
RECHECK:
Comments and/or diagram
Soil Type: Sand/. PO (g3t
i(<91)
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 Field: Total length ft. qtr...- 6.
Length of each trench ft. 1
v
Depth of trenches ft. ' ip t •
•
Size of Stone .,---
Seepage Pits: Number
Size: x
Stone Size: �t 1 0__
Piping Size Type y�-�� �V
Building to tank •a�r' SCIA 40 . A-5 � �
Tank to Distribution Box 4` 5f12 3 C
Distribution Box to Feld/ Pit Q y)2r 3 C pa �—
Opening Sealed: • i'/---N
End Cap '/1r^N
Inlet/Outlet Pipes&Baffles JY ri .
Manholes 12'or less below grade _Y
(provide extension collar if Yes] Y
Location/ Separations
Foundation an or tion ft. Lc� '
Foundation to absorption ft. ��WU`f`�-- kC ,�2 —, j
Separation of Pits ft. J o �� w���bb
Conforms as per Plot Plan _Y_N
Engineer Report and As-Built _Y N
ETU Maintenance Contract _Y_ N
provided
Location of System on Pro
Front R r Left Side ight Side Middle Front Middle Rear
mUse S
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010W1ding Codes Forms\Inspection Forrrs\Septic Irspedion Report33 2910.dac
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