2008-336 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4z Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080336 Date Issued: Tuesday, August 31, 2010
This is to certify that work requested to be done as shown by Permit Number P20080336
has been completed.
Tax Map Number. 523400-309-018-0001-003-000-0000
Location: 16 ISLAND VIEW Dr
Owner. WINSLOW & JOANNA MC GUIRE
Applicant: WINSLOW & JOANNA MC GUIRE
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 c— �f4
property owner of the responsibility for compliance with Site Plan, ` r
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 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080336 Application Number. A20080336
Tax Map No: 523400-309-018-0001-003-000-0000
Permission is hereby granted to: WINSLOW&JOANNA MC GUIRE
For property located at: 16 ISLAND VIEW 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. Tyne of Construction Value
Owner Address: WINSLOW &JOANNA MC GUIRE
16 ISLAND VIEW Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2008-336
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,June 26,2009
(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=It-4v:PW
eur h rsday June 26, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Co Enforcement
------------
OFFICE USE ONLY
01.. .
TAX MAP NO. PERMIT NO. 'PERMIT FEE
TOWN CLERK
o APPROVALS: ZONING
0
----------- ----------- ------------
APPLICATION FOR SEPTIC DISPOSAL SYSTrEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TqREVIEW BEFORE ISSUANCE OFAVALID
PERMIT
OWNER/ INSTALLERJ;, 5�c
ADDRESS:t4a L CA A-,,)LZi 4X4.z—d
PHONE NOS. :) V3 - 3gyl PHONE NOS.— 72
LOCATION OFINSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF x COMPUTATION= TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
INSTALLED?SPA OR HOT TUB
\wGTALLED?_______
PARCEL INFORMATION:
~/ : Flat rolling X Steep slope %8|upe_____
v' : Sand Loam C|ay______ Other-
GROUNDWATER: At what depdh?
At what depth?
: K8unicipa| �� W ell_ (if vve||: VVa1ersupply from any ompbo
' system absorption io t.)
Rate is per minute per inch.
(Test tobg�onnp\m0edbya licensed professional engineer oran:hitect]
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed Uy
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision).
TANK SIZE: 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.
TYPE:SYSTEM
��A (WITH To
tal . Each trench x
' ^
0 SEEPAGE P[TA8 (WITH NO. 3STONE) How many? Size?
El ALTERNATIVE SYSTEM Bed or other type?
F� 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.
| have read the regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queen y Sewage Disposal Ordi
VISIT OUR WESSITE FOR MORE INFORMATION
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Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 17804
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection iv
Queensbury Building&Code Enforcement Arrive: _ _ part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspecto s itial
NAME: 6IT NO.:
LOCATION: c..3 6r- SrECT ON:
RECHECK:
Comments and/or diaoram
Soil Type: Sand/ Loam ClayJ
T of Water: Municipal Well Water �Tk � `'Y�/
"0
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 N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade Y_N
[provide extension collar if Yes Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.--
Separation of Pits ft.
Conforms as per Plot Plan —Y—N
Engineer Report and As-Built —Y—N
ETU Maintenance Contract _Y_N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status
Approved
Partial Approved and needs to be re-inspected, please cads the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Bu11d1ng Codes Forms\Inspecdon Fomis\septic Inspection Repork_03 2910.doc