2013-545 Al'Skim TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130545 Date Issued: Monday, December 09, 2013
This is to certify that work requested to be done as shown by Permit Number P20130545
has been completed.
Tax Map Number: 523400-302-009-0001-005-000-0000
Location: 318 DIXON Rd
Owner: TERRY SLYWKA
Applicant:
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 Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
' 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
ET
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130545 Application Number: A20130545
Tax Map No: 523400-302-009-0001-005-000-0000
Permission is hereby granted to:
For property located at: 318 DIXON 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: TERRY SLYWKA Septic Alteration Residential
PO BOX 65 Total Value
DIAMOND POINT, NY 12824-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2013-545
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,December 02,2014
(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 Towrlif
eensbu • M da ,December 02,2013
SIGNED BY aarf 114' for the Town of Queensbury.
Director of Building& ode E\.rcement
•
NGV 2 7 2013
.•-:••-:1.-,7_ ., Community Development Office
----2.1.;,_.,-:;--,._ Town of Queensbury o 742 Bay Road = Queensbury, New York =12804
Office Use Only �j
TAX MAP NO.
-.96. - 1 r I- 5 PERMIT NO. / 3- 541 5 PERMIT FEE f O
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: r r t 1 �L L/ fr✓�Al INSTALLER: /q/1/i 71/1-i �J�t-t.te Jef.k.,,-C c'/I
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ADDRESS: /o /// '0P� AQd� Alr'c'r4iS` )- ADDRESS:PO G_ go, 22 V /�',�.J7
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PHONE NOS.S761-- - 66 F- -fa 7f 7 PHONE NOS. -S (if - 7r. 7-72C,2
LOCATION OF INSTALLATION:/(nCk
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
j 1980 or older X 150 = _ INSTALLED? Az'
1981-1991 X 130 = SPA OR HOT TUB
1992-present .� X 110 = ,3,Jit? INSTALLED? /—
PARCEL INFORMATION: '
✓ TOPOGRAPHY: FLAT ROLLING K STEEP SLOPE %SLOPE
I SOIL NATURE: SAND., LOAM CLAY OTHER
I GROUNDWATER: AT WHAT DEPTH? A'i-
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? dh/1-
✓ DOMESTIC WATER SUPLY: MUNICIPAL .< WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mph (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:/1f7-0 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 262v ft. Each trench .-5-62 X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
in 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—these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
• ry�Se. rage DisI Ordinance. codas nr)aueensburv.net
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' `J��r2" f/z� �3 VISIT OUR WEBSITE FOR MORE INFORMATION )
Signature of Person Responsible Date www.dueensburv.net
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256 3 ,Yl
Septic Inspection Report
Inspection request received: i )/ 3
Name: S� Ct)KO--- Inspected on: 49-- . i_a -'
Location: j e—Di? -6)A Arrive: � P•.m.
Permit No.: / 3- 5 <A5 Inspector's Initials:
!lents and/or dia.ram
Soil Typ:10.. .clay
Type of Water unto icipa Well Water
Waterline se aratons distance fV-.t.
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 7-De ft.
Length of each trench '�j'Cft.
Depth of trenches 2 ft.
Size of Stone —7
Seepage Pits: Number C�
Size: x
Stone Size:
Piping Size Type
Building to tank F7�-1L]l l f
Tank to Distribution Box LI r(
Distribution Box to Field/Pit4 i l t
Opening Sealed: / N
End Cap y N
Inlet/Outlet Pipes&Baffles ��
Manholes 12"or less below grade Y N
[provide extension collar if Yes]
Location/Separations
Foundation to tank 1U ft.
Foundation to absorption /ft-7,5
Separation of Pits .
Conforms as per Plot Plan N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y_N
Location of System on Property:
Front ear Left Side 'ight Slit Middle Front iddl
S stem Use St us:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
,
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SEPTIC PLOT PLAN ! ..._ r
I HAVE SEEN OR OBSERVED ALL OBJECTS ��', '�
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON • IS DOCUMENT. I HAVE PERSONALLY
MEASUR f 'EDI"Tr,�� SET FORT IS DIAGRAM.
�� . .
SfGNAT 'E DATE
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