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SEP-0781-2018
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-0781-2018 Date Issued: Tuesday, December 18, 2018 This is to certify that work requested to be done as shown by Permit Number SEP-0781-2018 has been completed. Tax Map Number: 302.14-2-22 Location: 20 DIXON CT Owner: Louis Rose Applicant: Center Project Services 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 34*t. 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. 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-0781-2018 Tax Map No: 302.14-2-22 Permission is hereby granted to: Sanitary Sewer Service For property located at: 20 DIXON CT 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: Louis Rose Septic Disposal-Residential $0.00 Owner Address: 20 Dixon CT Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Sanitary Sewer Service PO Box 224 Glens Falls,NY 12801 Plans&Specifications Residential Septic Alteration $ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,December 12, 2019 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Quee before exp' atio •:to/' Dated at the Town f Que s • /W• - y,December 12, 2018 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement etSEPTIC DISPOSAL PERMIT APPLICATION Office Use Only limn cfQucensburtcfa j 742 Bay Road,Queensbury, NY 12804S ` l�. P: 518-761-8256 www.queensbury.net Permit#: Tax Map ID#: 302.14-2-22 Permit Fee: $ 1S -`; Invoice#:�,Sr- t �— Project Location: 20 Dixon Court Septic Variance? Yes No Primary Owner(s) LOUIS ROSE Mailing Address 20 DIXON COURT Phone & Email 518-729-8382 j L5 t;' 9 � L III Installer/Builder Sanitary Sewer Services , Mailing Address Luzerne Road,Queensbury,NY DEC 1 1 2018 th . Phone & Email (518)796-3760/gdrellos@gmail.com TF Engineer g Center Project Services COL` Mailing Address 73 Sheridan Street,Glens Falls,NY 12801 Phone & Email (518)796-2515/tcenter36@yahoo.com Contact Person for Building&Code Compliance: Center Project Services/Saniatry Sewer phone: 796-2515/796-3760 RESIDENCE INFORMATION: Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes No 1980 or older Installed? (circle one) 1981-1991 Spa or Hot Tub Yes ©° Installed? (circle one) 1992-Present 3 110 330 PARCEL INFORMATION: Topography ✓ Flat Rolling Steep Slope %Slope Soil Nature ./ Sand / Loam Clay Other Groundwater At what depth? NONE OBSERVED Bedrock/Impervious material At what depth? MOTTLING AT 55" Domestic Water Supply I Municipal _Well (if well, water supply from any septic system absorption is_ft.) Percolation Test Rate: 1 to 2 per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: EXISTING TANK TO BE USED Tank size 1,000 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: ; Size: Alternative System Bed or other type: 15'(W)X 30'(L)BED 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: Thomas Center,P.E. a ent DATE: 12/10/2018 SIGNATURE^:�: l7 Town of Queensbury Building&Code Enforcement Revised February 2017 INSPECTION WORKSHEET (SEP-008912-2018) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal SEP-0781-2018Permit Case Number:Case Module: Tue Dec 18, 2018Passed Inspection Date:Inspection Status: John O'BrienSeptic Inspector:Inspection Type: 20 DIXON CT302.14-2-22 Job Address:Parcel Number: Queensbury, NY 12804 Contact TypeCompany NameName Granted PermissionSanitary Sewer Service ContractorSanitary Sewer Service ApplicantCenter Project Services EngineerCenter Project Services Primary OwnerRose, Louis Checklist ItemPassedComments Building Inspector NotesYES12/14/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report and As-Built 12/18/18 Septic System Approved - Received Engineer's Report and As-Built Type of Water: Municipal / Well WaterYESMunicipal Waterline separation distanceYES10' Absorbtion Fields: Total LengthYES95' 20' x 25' stone leach bed Length of Each TrenchYES4@20' with ends looped and charcoal vented Dec 18, 2018Page (1) INSPECTION WORKSHEET (SEP-008912-2018) Checklist ItemPassedComments Depth of TrenchesYES24"-36" Size of StoneYES#2 Building to TankYESExisting Tank to Distribution BoxYES4" sdr35 pvc Distribution box to Field / PitYES4" sdr35 pvc to 4" sdr35 pvc perforated End CapYESEnd looped Foundation to TankYESExisting 10' Foundation to AbsorptionYES20' + Conforms as per Plot PlanYES12/14/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report and As-Built 12/18/18 Septic System Approved - Received Engineer's Report and As-Built Engineer Report and As-BuiltYES12/14/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report and As-Built 12/18/18 Septic System Approved - Received Engineer's Report and As-Built Location of system on propertyYESEast side of property System Use StatusYES12/14/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report and As-Built 12/18/18 Septic System Approved - Received Engineer's Report and As-Built O'Brien, John (Inspector) Dec 18, 2018Page (2) INSPECTION WORKSHEET (SEP-008676-2018) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal SEP-0781-2018Permit Case Number:Case Module: Fri Dec 14, 2018Partial Pass Inspection Date:Inspection Status: John O'BrienSeptic Inspector:Inspection Type: 20 DIXON CT302.14-2-22 Job Address:Parcel Number: Queensbury, NY 12804 Contact TypeCompany NameName Primary OwnerRose, Louis ContractorSanitary Sewer Service EngineerCenter Project Services Checklist ItemPassedComments Building Inspector NotesNO12/14/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report and As-Built Type of Water: Municipal / Well WaterYESMunicipal Waterline separation distanceYES10' Absorbtion Fields: Total LengthYES95' 20' x 25' stone leach bed Length of Each TrenchYES4@20' with ends looped and charcoal vented Depth of TrenchesYES24"-36" Size of StoneYES#2 Dec 14, 2018Page (1) INSPECTION WORKSHEET (SEP-008676-2018) Checklist ItemPassedComments Building to TankYESExisting Tank to Distribution BoxYES4" sdr35 pvc Distribution box to Field / PitYES4" sdr35 pvc to 4" sdr35 pvc perforated End CapYESEnd looped Foundation to TankYESExisting 10' Foundation to AbsorptionYES20' + Conforms as per Plot PlanNO12/14/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report and As-Built Engineer Report and As-BuiltNO12/14/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report and As-Built Location of system on propertyYESEast side of property System Use StatusNO12/14/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report and As-Built O'Brien, John (Inspector) Dec 14, 2018Page (2)