2014-470 TOWN OF QUEENSBURY
trierig 742 Bay Road,Queensburv,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140470 Date Issued: Monday, October 27, 2014
This is to certify that work requested to be done as shown by Permit Number P20140470
has been completed.
Tax Map Number: 523400-304-017-0001-026-000-0000
Location: 79 BOULEVARD
Owner: CHERYL POETTE
Applicant: CHERYL POETTE
This structure maybe occupied as a:
Septic Alteration Residential By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ( CSV el
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
�_ J Planning Board or Zoning Board of Appeals.
a
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
ra
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140470 Application Number: A20140470
Tax Map No: 523400-304-017-0001-026-000-0000
Permission is hereby granted to: CHERYL POETTE
For property located at: 79 BOULEVARD
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: CHERYL POE 1 l E
Septic Alteration Residential
79 BOULEVARD
QUEENSBURY NY 12804-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
COUNTRY PLUMBER
MAURICE PADDOCK 518-222-3909
CLIFTON PARK NY 12065-0000
Plans&Specifications
2014-470
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, October 23,2015
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town f Quee sbury f ,O
,r Th . s ctober 23,2014
SIGNED BY G' 411 _ � for the Town of Queensbury.
,
Director of Building&Code Enforcement
rJ ,s
SEPTIC DISPOSAL PERMIT —TT
Ti
Only_,---
Office-Use nf/ t �j�}1
DATE 9160 114 rel? fiI '
III � celvedx Ma ID ��
TAX MAP ID ,to.,-,:p
11�p 3 201U �'�'%�•!�J-���o
permit NEEP /C1-91>v
Permit Fee46,—; - RY 1
LOCATION OF INSTALLATION N -QUt",.
Approvals 4 OF O rnDES _____.-1
BUILDIti�
A i
APPLICANT Q PHONE/E-MAIL
q 93 307q
ADDRESS i/�� B'?7) Ie .1frOi te> ait.) \?) / G'6 (/
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INSTALLER/BUILDER: P111-021 IG T6" -HONE/E�AIL c9Ol -:1-1 (2)ff', 1(2)ci
ADDRESS: ��1/�L a a ... , Ll .-L r ) .b
//
OWNER l Ill-Qf�[^p I �( C PHONE/E-MAIL
Address 1
•
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE:
PHONE
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older
an• `�
`"v Q a OD Garbage grinder installed _Y kN
1981-1991 Spa or Hot Tub installed _Y X N
1992-Present
PARCEL INFORMATION
Topography Yr Flat rolling Steep slope _%slope
Soil Nature XeSand x Loam
Clay Other
Groundwater
At what depth?
��
Bedrock/Impervious Material At what depth? 7(//9
Domestic Water Supply '$ Municipal _Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION -
Tank Size - N000 gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length 1.15-0 ft.; Each trench 3 x (.5-0i
Seepage Pit with#3 stone How many: ;size
Altemative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant,shall be void. I have read the regulations and
agree to abide by,4tese and all ire ents of the Town of Queensbury Sanitary Sewage Disposal
�/ l Ordinance.
Print Name: (( �ri/ -1/( O
Signature: 4. 1.
Date:
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
lilt
Septic Inspection Re• s •
Office No. (518) 761-8256 Date Ins•- to . rr : -
Queensbury Building &Code Enforcement Arrive: • : : .,. • :
742 Bay Rd., Queensbury, NY 12804 Inspectorsjf �V
Initia s• s
NAME: RET E. NO.: I4— U-76
LOCATION: -79 (3QBLE\\SaRD •ECi'ON: It\ - Z7- 114
RECHECK:
Al. Comments and/or diagram
Soil Ty.v oam/Clay
Type of Watereso '.. / Well Water
Wate ine separation distance 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 ft.
Length of each trench _ ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank `` , to
Tank to Distribution Box I` �Q`^,�
Distribution Box to Field/ Pit `' -VD-`p \4I Qa-
Opening Sealed:
End Cap
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade — _ N
[provide extension collar if Yes] _Y—N
Location/ Separations
Foundation to tankcM -Vo�r�
Foundation to absorption a ft. FR-
Separation of Pits ft.
Conforms as per Plot Plan _Y N
Engineer Report and As-Built _Y_N
ETU Maintenance Contract _Y_ N
provided
Location of System on P petty:
Front R r Left Side Right Side Middle Fron Mid.
stem Use S s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Form sUnspection Forms\Sepic Inspection Report_03 29 10.doc
SEPTIC PLOT PIAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
_Sk1CH AS Hfl EILS,TREES, EP7CES,ETC
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