SEP-0597-2018 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0597-2018 Date Issued: Thursday, September 27, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0597-2018
has been completed.
Tax Map Number: 301.8-1-45
Location: 378 AVIATION RD
Owner: Nancy Hafner
Applicant: Tony Signorelli
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (" 440 4
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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.
/AK TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0597-2018
Tax Map No: 301.8-1-45
Permission is hereby granted to: Tony Signorelli
For property located at: 378 AVIATION 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
Owner Name: Nancy Hafner Septic Disposal-Residential $0.00
Owner Address: 378 AVIATION RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Tony Signorelli
589 WEST MOUNTAIN RD
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, September 19,2019
(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 e expiration •.to.
Dated at the To of Que bury 4W . '. •, eptember 19,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
--3) % SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
742 Bay Road,Queensbury,NY 12804
town ofQuccn-tbury P:518-761-8256 Permit#: `SEA-- � � •20 It
Tax Map ID#: • 8 - -45 Permit Fee:$ ; Invoice#: b Fi J
Project Location: Abq-B Qy Septic Variance? Yes No
Primary Owner(s) AM Al( 'rn ve -
Mailing Address 37 7 4 K;.,,, Rer44
Phone & Email 0730
Installer/Builder � r er
Mailing Address S-S). i-1,/ .44
Phone & Email 9.61 a-«
Engineer
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: TQ.v c1 ,nov.t,``N Phone: 1cl 2-- 0 6
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes CD
1980 or older 150 3 I Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes �o
Installed? (circle one)
1992-Present 110
PARCEL INFORMATION:
Topography L Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? ---
Bedrock/Impervious material At what depth?
Domestic Water Supply Municipal _Well(if well,water supply from any septic system absorption is ft.)
Percolation Test ate: per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size / .-O gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
Seepage Pit with#3 stone How many: C ;Size:
Alternative System Bed or other type: 5-,t,(LT Q 4-'rt f
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 and approved.
The installed system must match the septic 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 known by or on behalf of an applicant,shall be void. I
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME: )6e " ` `�����1�� DATE: q l (P
SIGNATURE:
DATE: e7L ✓ f
Town of Queensbury Buildin &Code Enfo ement Revised March 2018
INSPECTION WORKSHEET (SEP-006911-2018)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
Case Number:
Inspection Date:
Inspector:
Case Module:
Inspection Status:
Inspection Type:
SEP-0597-2018
09/27/2018
John O'Brien
Permit
Passed
Septic
Job Address:Parcel Number:378 AVIATION RD
Queensbury, NY 12804
301.8-1-45
Contact Type Company Name Name
Contractor Signorelli, Tony
Granted Permission Signorelli, Tony
Primary Owner Hafner, Nancy
Applicant Signorelli, Tony
Checklist Item Passed Comments
Building Inspector Notes YES 9/25/18 Septic System Partial Approval
- 1000 gal Poly Septic Tank to first 3 Infiltrator Lines.
9/27/18 Septic System Approved
- Balance of System
Soil Type: Sand YES
Type of Water: Municipal / Well Water YES Municipal
Waterline separation distance YES
Absorbtion Fields: Total Length YES Partial 120' of 160' Installed and Ok to backfill.
Length of Each Trench YES Partial
3@40'
Depth of Trenches YES 18-24"
Building to Tank YES Not installed
4" sch40 pvc
Tank to Distribution Box YES 4" pvc
Distribution box to Field / Pit YES Partial
4" pvc to infiltrators
Opening Sealed:YES
End Cap YES Partial
InletOutlet Pipes & Baffles YES
Manholes 12 or less below grade YES
Locations / Separations YES
Foundation to Tank YES 10'
Foundation to Absorption YES 20' + to first line
Conforms as per Plot Plan YES
Location of system on property YES Rear left side.
System Use Status YES 9/25/18 Septic System Partial Approval
- 1000 gal Poly Septic Tank to first 3 Infiltrator Lines.
Sep 27, 2018 Page (1)
INSPECTION WORKSHEET (SEP-006911-2018)
Checklist Item Passed Comments
Call for inspection of the balance of the septic system.
9/27/18 Septic System Approved
- Balance of System
Sep 27, 2018 Page (2)
O'Brien, John (Inspector)
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