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2014-323
FOS TOWN OF QUEENSBURY ` S 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20140323 Date Issued: Wednesday, July 30, 2014 This is to certify that work requested to be done as shown by Permit Number P20140323 has been completed. Tax Map Number: 523400-296-017-0001-009-000-0000 Location: 14 CARLTON Dr Owner: RUTH A BETZ LE Applicant: RUTH A BETZ LE 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, f Variance, or other issues and conditions as a result of approvals by the Director of Building{i& Cod f?"or.:. ent Planning Board or Zoning Board of Appeals. j� TOWN OF QUEENSBURY A 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20140323 Application Number: A20140323 Tax Map No: 523400-296-017-0001-009-000-0000 Permission is hereby granted to: RUTH A BETZ LE For property located at: 14 CARLTON Dr 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: RUTH A BETZ LE L ASH & P ONEILL Septic Alteration Residential 14 CARLTON Dr Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications 2014-323 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 22,2015 (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 To Towr7nshe, July 22,2014 SIGNED BY Cf s for the Town of Queensbury. Director of Building& Code Enforcement t I1�1 i5 Cin i 1 toffee Use Only Town of Queensbury Buildingt& Codes te R : I In\ 31JL 21 2014 r� r a SEPTIC DISPOSAL PERMIT lax Map ID: (Q, ft? — -9 ennit t�o.: A permit must be obtained before beginning cpastruetion QUEENS 1 t /`3�l 3 BUILDING&CODE SAp $ Applicant At`•c //1 Ne)C InstallerBuilder S -4/11- Piled-..]r.". e Address l'� /4Dire Address Po./cr - t z-it Phone: Phone 777- 72i7 Owner. Location of Installation /y fl «' ^' P2 Address: Phone �/ Contact Person for Building&Code Compliance: t 7e©t b �J/ Day Phone:7%- 6U Residence Information: (/ Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow 1980 or older 2- x 150 = got Garbage Grinder installed? No 1981-1991 x 130 = Spa or Hot Tub Installed? yo 1992—Present x 110 Parcel Information: Topography V Flat Rolling _Steep Slope _%Slope Soil Nature X Sand _Loam Clay Other Groundwater At what depth? Bedroddtmperyious Material At what depth? Domestic Water Supply Municipal _Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate- /—S per minute per inch(Test to be completed by a licensed professional engineer or architect) prooesed System for New Construction: All indwidual sewage disposal systems must be designed by a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision). Tank size Awa gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub System Type: Absorption Feld(with#2 stone) Total length ft. Each trench 7 X Zo Seepage Pit S with#3 stone) How many? Size? Bed or other type? Zo X 7r • ank System Total required capacity? Tank size? #of tanks? NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system layout on file. There will be no exceptions. 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 to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Print Name: Date: Signature: C �-� 1/' ,j� `zj 7 1 —J Date: 1' Town of Queensbury Building&Codes Septic Disposal Penult 518-761-8256 Town of Queensbury Building &Code Enforcement /-3 Office No. (518) 761-8256 Ca P M7)\ Septic Inspection Report Inspection request received: Name: A efa. Inspected on: — _ %al Location: I C«XTo4 k V" Arrive: _t e-;SJ a.m. 11.Permit No.: I'{-3a 3 Inspector's Initials: _a� C. ents and/or dia.ram Soil Typ : San lay Type of W r: Municipal ell Water Waterline separation distance ,D ft.'s F tap'c •S�R� Well separation distance ft. Other wells: ft. Well Casing Length 50'+I- Y N N/A [150'to well required if NO] Absorption Field: Total length 35 ft Length of each trench 7f' ft. YL-0h F 00t-00?t-c) Depth of trenches 7 — ' r ft. Size of Stone z 2-- Seepage Pits: Number Size x Stone Size Piping Size Type Building to tank 4n c__ 4p Tank to Distribution Box i , - DistributionBox to Field/Pit y+) f DR 3r Tt 4".1, r. OpeningngSealed: /N� End Cap YV ✓N C-1 3S> Inlet/Outlet Pipes&Baffles Ns� �x�A c—a� Manholes 12"or less below grade �Y [provide extension collar if Yes] Y N Location/Separations Foundation to tank tit) ft. Foundation to absorption Ar Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N ETU Maintenance Contract provided Y N Location of S stem on Pro.e : Front Re. Left Side Right Side Middle Fron' Middle Rear S stem Use Stat .: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report At . � 0svI -. ( )K1 -3 � , at° c 0 y t Rirt O 4 ti O� rt °J tie SEPTIC PLOT PLAN HAVE SEEN OR OBSERVED ALL OBJECTS 'SUCH AS HOUSES, WELLS, TREES, FENCES, ETC SHO t ON THIS DOCUMENT.I HAVE PERSONALLY A. ' DTHEDISTA CE' FOR "N THIS DIAGRAM. >to'ATURE DATE 1 L� (rccrLi"DN Pair