2013-166 TOWN OF QUEENSBURY
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742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130166 Date Issued: Monday, May 06, 2013
This is to certify that work requested to be done as shown by Permit Number P20130166
has been completed.
Tax Map Number: 523400-309-009-0003-056-001-0000
Location: 11 VERMONT Ave
Owner: TODAY'S MODERN MOBILE HOME SALES, INC.
Applicant: TODAY'S MODERN MOBILE HOME SALES, INC.
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&Co a Enfo ement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
61,47 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130166 Application Number: A20130166
Tax Map No: 523400-309-009-0003-056-001-0000
Permission is hereby granted to: TODAY'S MODERN MOBILE HOME SALES. INC.
For property located at: 11 VERMONT 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: TODAY'S MODERN MOBILE HONE Septic Alteration Residential
PO BOX 4727 Total Value
SARATOGA SPRINGS,NY 12866-8
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2013-
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,May 01,2014
(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 u sbury We' •sr+.y,May 01,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY ,
TAX MAP NO.309',O _� - PERMIT NO. - 'KO 0
.? ERMIT FEE k"i' 3 0 2013
APPROVALS: ZONING
TOWN CLERK ,
o
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. A
L ES OWNER: (tiO�`�.f 440.02 CMJ/1U OCC- j�v1ESINSTALLER:� i,UC Joe (()
(.4/* 1/, 19. r.
ADDRESS: 0 /6 O y727
ADDRESS:
S nA7o&A _SP' /7/c5
PHONE NOS. /V Li
12796.
C� PHONE NOS. 7P-2Z2- 9
"NA
4e .LOCATION OF INSTALTION: / ,/1 �/�,Z
'n,
YEAR BUILT NO.OF X COMPUTATION= = RESIDENCE INFORMATION:
BEDROOMS TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED?
‘....,_ Q 1981 -1991
X 130 gallon per bedroom = g 9
1992-present X 110 gallon per bedroom = SPA INSTALLED?
ETUB
\ PARCEL INFORMATION: �Q� i C43/9/
L ✓ TOPOGRAPHY: Flat rolling Steep slope /oSlo e
—N\'%..1
P
✓ SOIL NATURE: Sand ( 1 Loam
Clay Other
✓ GROUNDWATER: At what depth? r/v
Ili
V BEDROCK/IMPERVIOUS MATERIAL: At what depth? G�-/1"
r
••/ : Municipal DOMESTIC WATER SUPLY: x Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is (` 5
per minute per inch.
(Test to be completed by a licensed professional engineer or architect.)
01 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).
I's..-.. TANK SIZE: GALLON (MIN. SIZE IS 1,000 00 GAL.) Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
C- SYSTEM TYPE:
Q. :, El ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
❑ SEEPAGE PITS) (WITH NO. 3 STONE) How many? Size?
ALTERNATIVE SYSTEM Bed or other type? 3-60 7tl_ff'-1 , V-/.,L.
❑ HOLDING TANK SYSTEM Total required capacity? �n�'� U�o�
CA S
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 QUESTIONS? CALL 761-8256 OR EMAIL
Quee sbury Sanitary Sewage Disposal Ordinance. codes@aueensburv.net
S 4
Sig ture of PVISIT OUR WEBSITE FOR MORE INFORMATION
/.. c.)//--? www.queensburv.net
erso esponsible Date
rrr Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req ,- • 7 hY
Queensbury Building & Code Enforcement Arrive:,,4-Da •� i• .rt: - al /pm )
742 Bay Rd., Queensbury,LNY 12804 Inspector's Initials• - - l
NAME: •IO 414 (S M r kn..ti ���/�'� ! 7 /1061
/ � � � • RMIT NO.: I
LOCATION: / / ye i2. Gv-T Ieit-e - INSPECT ON:
RECHECK: ,
Comments and/or diagram
Soil Ty P .am / Clay
Type of Water Municipal ell Water
Water - •. • ion distance p )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 \ t C) ft.
Length of each trench j, c. () ft. F I -��z__b
Depth of trenches 7_) ft.
Size of Stone
f
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 1.4 LI 4,4-N 40 34
Tank to Distribution Box
Distribution Box to Field/ Pit /t- tt 0T
Opening Sealed: ✓Yi_ N
End Cap ✓ N
Inlet/Outlet Pipes &Baffles N
Manholes 12"or less below grade Y— N
[provide extension collar if Yes] TY_ N
Location / Separations e v,\1-,T, b
Foundation to tank $,e) 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 Rear Left Side Right Side Middle Fr t Middle Rear
S stem Use Sta s:
Approved
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 Report 03 2910.doc
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