2008-303 � _'` TOWN OFQUE E NSBURY
Ba 742 y Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20080303 Date Issued: Thursday, August 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20080303
has been completed.
Tax Map Number. 523400-296-010-0001-065-000-0000
Location: 1 ST. ANDREWS Dr
Owner. EDWARD & GLORIA ALLARD
Applicant EDWARD & GLORIA ALLARD
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the , / , .
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
` w 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080303 Application Number. A20080303
Tax Map No: 523400-296-010-0001-065-000-0000
Permission is hereby granted to: EDWARD & GLORIA ALLARD
For property located at: 1 ST. ANDREWS Dr
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: EDWARD &GLORIA ALLARD
1 ST.ANDREWS Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2008-303
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,June 17,2009
(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 To of ensb , ► s �: ne 17, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
TAX•
2,c, �0_. /vJ FFICE USE ONLY.................... , r . �' r„�
•
rM -'
IT ®cam' I
PERMIT FEE {. j
APPROVALS: 2 {< r-
ZONINGls4
TOWN CLERK
_•
I
APPLICATION FORSEPTIC _ '
/ /
DISPOSAL SYSTEM ,�
PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. PERM I I I I I I
AERMIT. APPLICATION IS SUBJE I T.
OWNER: �--�1 � TO REVIEW BEFORE ISSUANCE OF
A VALID
INSTALLS . A-) /
ADDRESS: . ,� at__G—Li �^
`� ADDRESS: `0 J u
PHONE NOS, / Z - J/ J �J /
LOCATION OF INSTALLATION: PHONE NOS. / 9!0 — P � d
YEAR BUILT NO.OF ""
..-••••8.0" BEDROO I X COM
or older » » ..»».„...»..... ATION ............
X SI E
» ».»....... . 150 gallon ............. E INFORMATION:
TOTAL
1981 - ».,....,.. ..» per bedroom L RMATION.
DAILY FLOW ••
1991 "'••••• •.
t44 v
..,..M..,,..».»..»».,.»...............................».». 130 gallonIN 1992-present I X"" per bedroom
JI GRINDER
».»»».�........... X =
LED? R
gallon per bedroom ' t SPA OR EHOT D?
PARCEL INFORMATION: I...=................................... INSTAL TUB Nl�
' i T POGRAPHY: FLAT
ROLLING
/ --___ STEEP SLOPE %SLOPE
IL NATURE:SAND'
LOAM CLAY
v GROUNDWATER: OTHER__
WHAT DEPTH?`�AT WHAT DEPTH?
BEDROCK/IMPERVIO
� •QOMESTIC WATER SI Ipt v• MAT RIgL; AT
MUNICIPAL4ELL_
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION
v MCOLATON TEST: IS— FTPLETED BY A LICENSED PROFESSIONAL ENPER MIINUTE PER INCH (TEST TO BE
PROPOSED SYSTEM FOR NEW CONSTRUCTION: individual
GINEER OR ARCHITECT)
a licensed professional engineer or architect(unless installed in a Planning All sewageBoard approved systemss must be designed by
gallons to the size of the septic tank and leach field for each garbage rind
Board subdivision). Add 250
PTIC TANK: t? Fy,4-The grinder, spa or whirlpool tub.
GALLON (MIN. SIZE IS 1,000 GAL.) TIL FI
V
�TAL SYSTEM I �n�n E D: EACH TRENCH
H: FT,
--__FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH( FT. X e
FT.
v $IZE OF$TONE TO BE I ICED; #_a______
/DEPTH OR THICKNESS FT
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM:
LENGTH AND/OR SIZE
HOLDING TANK SYSTEM:(If required) NO. OF TANKS:----._/SIZE OF EACH
✓ GALLONS,/TOTAL CAPACITY,
--.__GAL.
Ij NOTE: AI-ARM SYSTEM AND ASSOCIATED
ED BY A TO
APPROVED ELECTRICAL INSPECTION ELECTRICAL WORK MUST BE INSPECT """"' ,
AGENCY. PLEASE REVIEW LIST PROVIDED TOWN
:..:.:.::...:.:.:...:..•:.:.:.,.:.:.:.:.:.,.•:.:.:.,,:..:...,,,,,,,:,:.,:, :, :..::...,:.:.:.:,:::,,:::.,::..•:.::,:.:,, i
For your protection, please note that
;
permit or approval granted which is based upon oor is grated ion reliance upof the on Town of Queensbury, any
failure to make a material fact or circumstance known by or on behalf of an applicant, shall
p any material misrepresentation or
I have read the regulations with respect to this application and be void.
agree to abide by these and all requirements Of the Town of QUESTIONS
sbury San'tary Sewage Disposal Ordinance. CALL 761-8256 OR EMAIL
codes@d jaw
^ VISIT OUR WEBSITE FOR MORE INFORMATION
Ignature of P rson Respons le d / v Www•aueensbury net
ate
�S Town of Queensbury • Community Development Office • 742 Bay Road, Queensbur N y, Y 12804
(2_ : cc)
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r quest received:
Queensbury Building &Code Enforcement Arrive: 'Z., '5 am/pP Depart: am/pm
742 Bay Rd., Queensbu , 12804 Inspector's Initials: JC--
NAME: r . PERMIT NO.: 06&LOCATION: �-" 4ti,.., ret f' INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Ty,- Sand. oam/ Clay
Type of Water: pa ell Water
Waterli - --•. . ion distance 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 /e/ N <<
Stone Size: �jj �� / k RO Sc L,,
Piping e Type
7U
Building to tank fiC/-j ilk 1,>P-1-C7 'Pic.4 1 d e' 00/9 5
Tank to Distribution Box �/�t ��° �
Distribution Box to Field / Pit
Opening Sealed: _Y N
End Cap _Y_N
Inlet/Outlet Pipes&Baffles T N
Location/ Separations
Foundation to tank A-ft.
Foundation to absorption
Separation of Pits
Conforms as per Plot Plan _ Y N
Engineer Report and As-Built Y N
Location - stem on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S us
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
Community Development Office
Town of Queensbury • 742 Bay Rd.
Queensbury, New York •12804 PLOT PLAN.
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
SIDE PROPERTY LINE
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