2013-127 TOWN OF QUEENSBURY
irw742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130127 Date Issued: Monday, April 15, 2013
This is to certify that work requested to be done as shown by Permit Number P20130127
has been completed.
Tax Map Number: 523400-308-006-0001-042-000-0000
Location: 76 BURCH Rd
Owner: CHRISTOPHER & PAMELA ANN HEIL
Applicant: CHRISTOPHER & PAMELA ANN HEIL
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 \ /J
property owner of the responsibility for compliance with Site Plan, w/ )
Variance, or other issues and conditions as a result of approvals by the Director of Building& Code nforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130127 Application Number: A20130127
Tax Map No: 523400-308-006-0001-042-000-0000
Permission is hereby granted to: CHRISTOPHER&PAMELA ANN HEIL
For property located at: 76 BURCH 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. Type of Construction Value
Owner Address: CHRISTOPHER& PAMELA ANN H
76 BURCH Rd Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builders Name /Address Electrical Inspection Agency
ML CONTRACTING
798-0317 OR 955-8168
34 WARREN Ln
OUEENSBURYNY 12804-0000
Plans&Specifications
2013-127
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 To eensb ; ( d ,April 08,2013
SIGNED BY for the Town of Queensbury.
Director of Building& ode En orcement
•, ; Community Development Office _APR 05 2013
1
Town of Queensbury • 742 Bay Road • Queensbury, New York .12804
Office Use Only3? Q I 2
3
TAX MAP NO. 0 t�• le -- I-19 A PERMIT NO. -1 4612 PERMIT FEE dip a)
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: ash/AA:s £ Pam nHe, l� INSTALLER 1/,//L. ConigAe rTArG �vD `�
ADDRESS: I(O [*I-&C✓�H R i , (DutENSBIffC,/ ADDRESS: 3V vG I age-Ai nLgNe- l gt- s&q,c
PHONE NOS. ( q ✓� - 1 2_3 PHONE NOS. 9911-d -63 1 7 / 7 55 -(/41
LOCATION OF INSTALLATION: 14 /.l X Cii Rn nig - /3w E( AJS t?they NV /07 Fol
RESIDENCE INFORMATION:
NO.OF COMPUTATION = TOTAL DAILY FLOW
YEAR BUILT BEDROOMS X (Gallons per bedroom) GARBAGE GRINDER
1960 or older 3 X 150 = LI 5 0 INSTALLED? /VD
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLUNG/1 STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND /r LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
I DOMESTIC WATER SUPLY: MUNICIPAL X WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS 3 - 5 PER MIINUTE PER INCH[mai] (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: //WO 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 lengthaft. Each trench (4 X 50
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
o 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 regulations with respect to this application and agree to -
abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 7614256 OR EMAIL
Sanitary 4.../ atcDisposalWe codes( aFORM RE et
INd�/t�r�+a�� 9�`�'�`'�- VISR OUR WE ;FOR MORE INFORMATION
Signature of Person Responsible www.oueensburv.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm rt. am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: a
NAME: 4a l ( PERMIT NO.: 13– a.7
LOCATION: '1 Lo 6itrCin (fid INSPECT ON: E k-3
RECHECK:
Comments and/or diagram
Soil Type: n Loam/ Clay
Type of Water: M ipal/ Well Water
Waterline separation distance ft.
Well separation distance R.
Other wells: R.
Well Casing Length 50' +/ - Y N_N/A
[150'to well required if NO]
Absorption Field: Total length 4-00 ft.
Length of each trench 5 ft.
Depth of trenches /1512d" ft.
SizeStone
Seepage Pits:: Number
Size:
Stone Size:
Piping 4ize Type
Building to tank "- 4–Ato
Tank to Distribution Box `c
Distribution Box to Field/ Pit 4 r q�-7 t
Opening Sealed: Q/Y N
End Cap y_N
Inlet/Outlet Pipes&Baffles '✓Y
Manholes 12"or less below grade =Y N
[provide extension collar if Yes] Y
Location/ Separations
Foundation to tank 2.7-tft.
Foundation to absorption .2� ft. BUILTAS
Separation of Pits
Conforms as per P _ N
Engineer Report and Y—N
ETU Maintenance Contract Y N
provided — —
Location of Systemn Property:
Front / Rear/ Left Side Right Side Middle Front Middle Rear
System Use Stat
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes FonnsUn spedon Forms eptic Inspection Report_03 29 10.doc
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