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2009-596 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090596 Application Number. A20090596 Tax Map No: 523400-308-018-0001-046-000-0000 Permission is hereby granted to: JOSEPH & STEPHANIE AFFINITO For property located at: 47 REVERE 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 Value Owner Address: JOSEPH & STEPHANIE AFFINITO Septic Alteration Residential 47 REVERE Rd QUEENSBURY,NY 12804-0000 Total value Contractor or Builder's Name/Address Electrical Inspection Agency STONE INSTALLATIONS NY 12804-0000 Plans &Specifications 2009-596 septic alteration -- $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,December 08, 2010 (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 To f, n#s ry; es ay,December 08,2009 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement i ___�_ J_- OFFICE USE ONLY'�r'_ _._r + %_.__.____.___...____:i TAX MAP NO. PERMIT NO. 5 PERMIT FEE APPROVALS: ZONING TOWN CLERK 0 ' / I ...r.._r_..__ ..� .l.r ._ _..._...__..._._J _ APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT, r A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. ? �i L OWNER: �U 5 INSTALLER: � f ! 5u !!tM 4 L l lXv-Ff07S 3 � " 5"5 S•Z'GI�7 —1 ADDRESS: I95 ADDRESS: L fC PHONE NOS. 11PHONE NOS. G I 7 U�U L LOCATION OF INSTALLATION: `/GV RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW BEDROOMS GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat roiling Steep slope %Slope ✓ SOIL NATURE: Sand_ Loam Clay Other ✓ GROUNDWATER: At what depth? ndlief IQ ✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? ✓ DOMESTIC WATER SUPLY: Municipal_ Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is per minute per inch. (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: f _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. SYSTEM TYPE: ffj (� 1.(vw4 v) i ABSORPTION FIELD ) Total length a( i_ft. Each trench X ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ ALTERNATIVE SYSTEM Bed or other type? ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? 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. Y7 '00e`l- 1 ac, ,Al r lz&,�l C4 V-e�7 0 f C,",r.# S'i$-30 -/3 is zU�� �c7 ee ��d �d 'vocs 'OWN OF QUREt2- e BUILDING & C,J,�> �l ,., t�v Reviewd Sy: ,, iis 1 I NrrT is v oz C � i c�H O b/9 5 ofer-L'4 s'7',�t " •,c /C, 4'VIC f t Tic �n�G� r -----------: p�0 lk►h � I c n ©fs�flz c�'•� wxl/ .� �Holt ��.� �' V� �liN 2.� � /'1 � �:I'a'7C fit✓! /H `. ` ) C�'? a e. je ve�t�� �#,e f i a ( Arlr4,eCD �.> .. Z. 1-5 w zA, 1 Rough Plumbing / Insulation Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building & Cade Enforcement Arrive: �,' am/pm Depart: amipm 742 Bay Road, Queensbury, NY 12804 Inspector's Initials: -Q ______ NAME: PERMIT#: LOCATION: INSPECT ON: TYPE OF STRUCTURE: Y N N/A Roug Plumbino Nail Plates :Plu in V /Vents in Place 11.leef" 1 V2 inch minimum Drain Size Washing Machine Drain 2 inch minimum ' Cleanout every 100 feet/change of direction Pressure Test Drain/Vent Air/Head 5 P.S.I. or 10 ft. above highest connection for 15 minutes Pressure Test Water Supply Piping Air/Head 50 P.S.1 for 15 minutes Insulation/Residential Check/Commercial Check Tyvek or Similar Exterior Sealant Proper Vent, Attic Vent Door/Window Sealed No Insulation Duct/ Hot Water Piping Insulation If required unheated aces Combustion Air Supply for Furnace Duct work sealed properly/No duct tape COMMENTS: Rough Plumbing Insulation Report.revised Nov 17 2003, revised February 15,2005, revised January 7,2008 Septic Inspection Rep rtr Office No. (518) 761-8256 Date Inspection req st i Queensbury Building &Code Enforcement Arrive: 'K—Xb a /p part: a� 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials 617 NAME: PE WF NO.: LOCATION: INL-G(ECT ON: RECHECK: 4411 Comments and/or diagram Soil Typj. San oam/ Clay Type of Water: al Well Water Waterline separation distance h' ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N A 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 BoxVt� Distribution Box to Field Pit Opening Sealed: N End Ca _ N Inlet/Outlet Pipes &Baffles N Location Separations Foundation to tank ft. Foundation to absorption Separation of Pits ft. Conforms as per Plot Plan Y_ N Engineer Report and As-Built Y_ N Location of System on Property: Front Re Left Side Right Side Middle Front iddle Rear S s m U s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc