2013-007 01W TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20130007 Date Issued: Thursday, March 26, 2015
This is to certify that work requested to be done as shown by Permit Number P20130007
has been completed.
Location: 6 REGINALD Dr
Tax Map Number: 523400-302-009-0001-011-000-0000
Owner: PAUL LING
Applicant: DAWN WING
This structure may be occupied as a:
Septic Alteration Residential By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property �,f
owner of the responsibility for compliance with Site Plan, Variance, or VVV ,g4--•
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
Community Development Office JAN U 7 2013
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only y 2
it
TAX MAP NO. .39a, PERMIT NO. 13-aD _ PERMIT FEE �� '
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFOREWORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: DaW \Arlr`5 INSTALLER: 11)5 Sglf 1
ADDRESS: ' O �pe f�t n41 Dr• ADDRESS: ` L O WQpE WpG((p 'S I • �10 1.
PHONE NOS. 681-12)1—L2) T / t1 /PHONE NOS. C It�� I 0 1 1 1
LOCATION OF INSTALLATION: 6 RC 51^c`,tt 0
1 RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older N t', X 150 = N R INSTALLED? N�
1981 -1991 t 3 X 130 = 39 Q SPA OR HOT�tJ
1992-present I\i� X 110 = INSTALLED? IN
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT R9[LING STEEP SLOPE N[y %SLOPE IV 1
✓ SOIL NATURE: SAND ✓ LOAM N CN CLAY N t OTHER 1\11-‘,
✓ GROUNDWATER: AT WHAT DEPTH? \V ,I (�
I BEDROCK/IMPERVIOUS MATERIAL: AT WIjAT DEPTH`?,Iv
✓ DOMESTIC WATER SUPLY: MUNICIPALyJ WELLIV H- (If well:water supply from any septic system absorption is: R)
✓ PERCOLATION TEST: RATE IS IV (! 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 Planning Board approved subdivision).
TANK SIZE: 10(1(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.
yPE:
SYSTEM TABSORPTION FIELD (WITH NO.2 STONE) Total length [Z� ft. Each trench �f X
m❑/ N cofSEEPAGE PIT(S)(WITH NO. 3 STONE) How many?� C Size? N N
o ALTERNATIVE SYSTEM Bed or other type? R n
o HOLDING TANK SYSTEM Total required capacity? N Tank size? Xj R Number of tanks?N hnt
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 Queensbury QUESTIONS? CALL 761.8256 OR EMAIL
Sani ry e e Disposal Ordinance. codeseaueensburv.net
Signature rsontResponsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.gueensburv.net
Town of Queensbury Building &Code Enforcement
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: Wein` ; Inspected on: —
Location: ( RFC EGt As Li) Desk JF Arrive: • &v 1 h :.m.
Permit No.: 13 —n67 Inspector's Initials: V VP-
-—
om -ntsand/or dia•ram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline 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
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed. Y N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12'or less below grade Y N
[provide extension collar if Yes] Y N 4C CD
\
Location/Separations
Foundation to tank ft. \
Foundation to absorption
Separation of Pits
Conforms as per Plot _N
Engineer Report d As-Buil \i/1
Y N
ETU Maintenance ontract provided Y N
Location of System on Property:
Front R r Left Side Right Side Middle Front Middle Rear
S stem Use Sta s:
Approved /
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved '/
Septic Inspection Report
' I 0 - 1 -1-- Ll ed A e.Sdatt
C [(25e-1-01 0 ATW
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection y ,.
Queensbury Building &Code Enforcement Arrive r►. ' i.17. %_,.rt: i' lr . ,m
742 Bay Rd., Queensbury, NY 12804 Inspector's I y;, _: ` )
NAME: t.i(r Q 1�1 rr NO.: ! 3 - oil?
LOCATION: (,p 9fG ' • ON: /-9--/3
RECHECK:
aComments and/or diagram
Soil Type: � ., m/pay
Type of Water Mu frell Water
Wate _._ - :. . once rQoa"F `,A ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - _Y N_N/A
[150'to well required if NO]
Absorption Reid: Total length ZOO ft.
Length of each trench 14 CS)
—'-1 ft. CqD Lpp � kzI v�.E \--r--
Depth of trenches 1
Size of Stone a_
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank /�u P-oc Es- rbTI t3G
Tank to Distribution Box y it W(:
Distribution Box to Field/ Piti r PUC 321 4 PEgC
Opening Sealed: N
End Cap _ L�I'�
Inlet/Outlet Pipes&Baffles EA9 �rP � wl Jd= -
Manholes 12"or less below grade N
[provide extension collar if Yes] _Y N
Location/Separations
Foundation to tank l%..445i.ft.
Foundation to absorption ft. A 6V:A BUILT B U I LT
Separation of Pits
Conforms as perPI n N
Engineer Report an -BuiJV Y_N
ETU Maintenance Y_N
provided
Location of System on Property:
Front RearSide Right Side Middle Front Middle Rear
System Use Sta •
V Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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