2014-160 _� ` TOWN OF QUEENSBURY
` 3 742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140160 Date Issued: Tuesday, May 13, 2014
This is to certify that work requested to be done as shown by Permit Number P20140160
has been completed.
Tax Map Number: 523400-301-017-0002-011-000-0000
Location: 11 CHEROKEE Ln
Owner: THOMAS & PAMELA DE GROFF
Applicant: THOMAS & PAMELA DE GROFF
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of Certificate of Compliance DOES NOT eSite 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 nfor ent
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: P20140160 Application Number: A20140160
Tax Map No: 523400-301-017-0002-011-000-0000
Permission is hereby granted to: THOMAS & PAMELA DE GROFF
For property located at: 11 CHEROKEE Ln
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: THOMAS &PAMELA DE GROFF Septic Alteration Residential
11 CHEROKEE Ln Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY.NY 12804
Plans&Specifications
2014-160
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,May 07, 2015
(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 f Que sbu / 4 w:1 i e-'.- ay 07,2014
SIGNED BY - for the Town of Queensbury.
Director of Building&Code Enforcement
€ .i,„-,-__ Community Development Office r--,rt.
4=-.�= G1 V14„ �.�,, Town of Queensbury • 742 Bay Road • Queensbury, Ne � ��` 280Y
Office Use Only �-I •� 1 ``V .� OUgENSg�RI
TAX MAP NO.3oI it /-�” I I PERMIT NO. /41-1b6 \\\
ERM:it FEE-MG& E
APPROVALS: ZONING TOWN CLERK � � f/
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGII�NS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER —17\ 1'h IJP t` (A c c INSTALLER: LG S SC�+1 Ai/C' 1
ADDRESS: t 1 /�tyq/r o e t 'I\ . ADDRESS: 1 Low R r \ `�or(C/"S I-•
PHONE NOS_ 61— 1 6Qt PHONE NOS. - / 0 -�1• 1 q
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT
NO. X COMPUTATION = TOTAL DAILY FLOW
BE ODMS (Gallons per bedroom) GARBAGE GRIN
1980 or older 1k.
k. X 150 = IV i- INSTALLED?
1981-1991 v X — 130 = ; 4{} SPA OR HOT TL
1992-present A X 110 = Iv I5 INSTALLED?
Illiit
PARCEL INFORMATION: t 4 I (� r�'T{
I TOPOGRAPHY: FLAT RO NG ✓ STEEP SLOPE_ %SLOPE IV II` A
I SOIL NATURE: SAND I L'{O�AM CLAY IV % °THER_ /1k
✓ GROUNDWATER AT WHAT DEPTH? N 1 1
I BEDROCK/IMPERVIOUS MATERIAL: AT WHA FPTH? V R
I DOMESTIC WATER SUPLY: MUNICIPAL/ WELL N k(If well:water supply from any septic system absorption is: it)
I PERCOLATION TEST: RATE IS lV11\ PER MIINUTE PER INCH[mpg (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 t,Planning Board approved subdivision).
TANK SIZE:I fit}S+1 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 TWPE: fy n(
ABSORPTION FIELD(WITH NO.2 STONE) Total length 20 0 ft. Each trench/ X• ST`j
o SEEPAGE PIT(S)(WITH NO.3 STONE) How many? IV f` Size? IV EN'
Lt .
O ALTERNATIVE SYSTEM Bed or other type? IIb / (1
❑HOLDING TANK SYSTEM Total required capacity? _ V I\ Tank size? V Ir t Number of tanks? Iv I 1
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 grantedinreliance 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 regula r. L ' respect to this application and agree to -
abide by theso idAir Sanitary 3 it-poral Ordinance the Townof Queensbury QUESTIONS 7CALLsenue 7611-8250 nsb r et EMAIL
-i"
/ `1 Lt VISIT OUR WEBSITE FOR MORE INFORMATION
Signet" / Person Responsible Date www.oueensburv_net ,
i
.r .
Town of Queensbury Building &Code Enforcement 'rr I cl coq LC) Cf M
Office No. (518) 761-8256 d
Septic Inspection Report
Inspection request received:
� �—
Name: L) e Cr r o �� Inspected on: 5–CH I
Location: II Ofie r ah'e.e- Arrive: _ - a. m. 1 p.m.
Permit No.: ) y-_/ (o D Inspector's Initials: iaa
Comments and/or diagram
Soil Type an Clay
Type of Wa er: unicip /Well Water
Waterline separ istance N. ft►J t
Well separation distance '' ■ ' _
Other wells: Ji li ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length 2s4) ft
Length of each trench ft.
Depth of trenches AO
Size of Stone
Seepage Pits' Number
Size: Villini x
Stone Size:
Piping Size Type
Building to tank c – `Lkko
Tank to Distribution Box 4" -2.61, -3 5-
Distribution
Distribution Box to Field I Pit Art` .ate 73‹f<42-17-
N�
Opening Sealed: Y_�`
End Cap —N
Inlet/Outlet Pipes&Baffles v*/_N
Manholes 12"or less below grade N
[provide extension collar if Yes] Y N
Location/Separations ,per' �—
Foundation to tank .`__t(, �=-- Jct G 3 �`��ic
Foundation to absorption Z% ft.
Separation of Pits /.J]4-ft-
Conforms as per Plot Pla fly +- N
Engineer Report an A -Buil t/Y N
ETU Maintenance Con ract provided Y N
Location of S stem o ' !.e :
Front eft Side Right Side Middle Front Middle Rear
OF
S stem Use Stat
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
VN The Leader
g1 as5Is F.W. WEBB COMPANY in Distribution '
Albany
17 Erie Boulevard
Albany.NY 12204
. 518.472.9322
. 800.432.9322
ti^ r Fax:518A72.9399
^ 1 Binghamton
C"' 2\ 62 Griswold Street
Binghamton,NY 13904
n 607.724.3170
tiet 888.593.9322
Fax:607.724.4369 '
n i
i
f Clyde
el. 80 Davis Parkway
,y.0 p 0� Clyde,NY 14433
N % C' G P" a, 315.923.7819
r : l f F 800.828.8824
ieer ? 'O Fax:315.923.3794
/ / ii, f3
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4... --2A , Plattsburgh
dr' ` 7327 Rte 9
Liao1
9 Plattsburgh,NY 12901
p 518.562.2575
-� ti 800.622.9322
/A !I_ v Fax:518.562.0117
Ff e F
31/4
?v, Queensbury
3 Highland Avenue
"I -/ / Queensbury,NY 12804
518.792.1316
800.826.0326
1 '� **%:.
Fax:518.792.1335
ill1-1
n Syracuse
n 0`^ r) V 158 Syracuse Street
p
J/ ft .yr nSyracuse,NY 13204
01 _3 1 it J/ 315.476.9322
XI 0 ::.,r,' 800.262.9222
—orl 4-1 (p t Fax:315.472.4139
ro
Utica
' !
415 Broad Street
2tr. T
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...V Utica..NY 13501
NI
�./,. 315.724.3191
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N .A,Y Fax:315.724.4067
t New Jersey Office:
973.696.0745
i Fax:973.696.0680
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LIYORK Masoneilan XOMOX TIFL!PE "1e9a spi' arco 7YLe%KM
BRADFORD WNrrE. /J1 ( f/�np�p[] _ S
RIDGID Johnson `I�'`) t" -p_ 3M w� man' (� N��IGYaIve1
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Controls Hone ell
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AHEAD OF THE HOW
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le Int^ 6 6 dot Mi 1 SEPTIC PLOT PLAN
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I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
MEAS T ISTANCE SET FORTH ON TH DIAGRAM.
R. SIGNAT REQ DATE
0- Qo)
. /9 ,C•Ra ci--9-i4
40
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Ton-. De to MAY 072014 D
QUEENS
CQ�ES
RY
TOWN OF QUEct',. 3'�RY
BUILDING & -5D�'. :2F'� ` 1/vinTc� (�
Reviewed By, _ �._ . 0 r ' vC
Date: 5�I''� / I t re. wU y
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