2008-363 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
4z Community Development- Building &Codes (518) 761-8256
CE RT I F I CAT E aF COMPLIANCE
Permit Number. P20080363 Date Issued: Monday, July 28, 2008
This is to certify that work requested to be done as shown by Permit Number P20080363
has been completed.
Tax Map Number. 523400-289-011-0002-012-000-0000
Location: 15 COUNTRY COLONY Rd
Owner: MARK RUTA
Applicant: MARK RUTA
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
(2t 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080363 Application Number. A20080363
Tax Map No: 523400-289-011-0002-012-000-0000
Permission is hereby granted to: MARK RUTA
For property located at: 15 COUNTRY COLONY 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: MARK RUTA
TERI WELLS Septic Alteration Residential
15 COUNTRY COLONY Rd Total value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
ELLSWORTH & SON EXCAVATING
ROUTE 149
FORT ANN, NY 12827-0000
Plans &Specifications
2008-363
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,July 07, 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 b ' , July 07 2008
�tz�
SIGNED BY V for the Town of Queensbury.
Director of Building&Code Enforcement
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- /2 OFFICE USE ONLY ? ' X'
i TAX MAP NO. -PERMIT N0. „ PERMIT FEES
APPROVALS: ZONING TOWN CLERK
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APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT]
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
I IG� h a P� 1 I EH�Vvzwtk
OWNER:
INSTALLER:
ADDRESS:) .5 O O W CQ� D; , �Cl. ADDRESS' ( U 3' � 1� I `I
PHONE NOS, ' ! f PHONE NOS. _ g
LOCATION OF INSTALLATION:
_ RESIDENCE INFORMATION:
»
YEAR BUILT X " COMPUTATION: .» TOTAL DAILY FLOW
»
_ BEDROOMS _ „„.........».»»»»».»....»»... GARBAGE GRINDER
1980 or older»r »» „» X» »160 gallon per bedroom :» »»U y C�C)„ »µ»µ INSTALLED?
µ 1981-1991 X 130 gallon per bedroom :µ » „�„„ SPA OR HOT TUBS
»»1992 present ».N..»»••......»»»»»».»»»X.» ....110 gallon per•bedroom» _'»........»•....».».•.......»»..»................................ INSTALLED?
PARCEL INFORMATION:
✓ .TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE:SAND LOAM CLAY OTHER
✓ GRQUNDWATER: AT WHAT DEPTH? BEDROCIOMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL--,- WELL..
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS Ab FT.
✓ PERCOLATION TEST: RATE IS , PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR AP.CYITECT)
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).Add 250
gallons to the size of the septic tank and leach field for each garbage grinder,spa or whirlpool tub..
✓ SEPTIC TANK, .��GA L ON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: 2� FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH—Al/ -
- .X FT.
✓ SIZE OF STONE TO BE USED:# Z- !DEPTH OR THICKNESS FT,
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE ST M: LENGTH AND/OR SIZE
✓ HOLDING TA ST required) NO.OF TANKS: /SIZE OF EACH
✓ GALLONS.!TOTAL C PACITY: GAL,
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NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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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,
I have read the regulations with respect to this application and
agree to abide by these and all requirements of the Town of Q
UESTIONS1.5288 OR EMAtt
Queen ry Sanitary Se age Disposal Ordin nce. sburvnet
/ MORE INFORMATION
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S196644 of Person Responsible D to
Town of Queensbury ■ Community Development Office ■ 742 Bay Road, Queensbury,NY 12804
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Septic Inspection Report
Office No. (518) 761-8256 Date Ins on request received:
Queensbury Building &Code Enforcement Arrive: 5S 3 ar Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials.
NAME: v 4 PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + - I 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 Box
Distribution Box to Field Pit
Opening Sealed: Y N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank ft. ��
Foundation to absorption ft.
Separation of Pits ft. ox
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
Svstem Use us:
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-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheirn,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No....4...................... ...Cert. N 2 4547 Cut-in Card No.....................................
Owner.............. ...............
................
Location....I . . .........Y
Installation Consisting of
eY-
...............................................
....................................................................................................................................................................................
....................................................................................................................................................................................
InstalledBy.......... ........................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the pn 'leg of mak' .nspections at any time, and if its
re gh to r k t s ifi rules a violated,the Company shall have the ri u5p4z
Date..... ............. INSPECTOR............................................................................................
Septic Inspection Report
Office No. (518) 761-8256 Date Ins iq�n equest received:
Queensbury Building&Code Enforcement Arrive: �1 am/p )/ epart: am/pm
742 Bay Rd., Queensbury, N�16
804 Inspector's Initials: -I,
NAME: PERMIT NO.:
LOCATION: CINSPECT ON: 7
RECHECK:
Comments and/or diagram
Soil Type: San Lo
Type of Water: Munici I Well W
Waterline separation distance ft.
Well separation distance —ft.
Other wells:
Well Casing Length 50' + / - Y N NJA
Absorption Field: Total length Xjo ft.
Length of each trench ft.
Depth of trenches Z, ft.
Size of Stone Z,
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank is
Tank to Distribution Box 2" v �-
Distribution Box to Field/ Pit w
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes&Baffles Y N
Location Separations -'j t� 19d, /►c
Foundation to tank ft.
Foundation to absorption 3 ft.
Separation of Pits
Conforms as per Plot Plan Y N � e
Engineer Report and As-Built N
Location of System on Property:
Front ear Left Side Right Side Middle Front Middle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 1-:\130ding&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
Septic Inspection Report
Office No. (518)761-8256 Date Inspe tion request received:
Queensbury Building&Code Enforcement Arrive: f< am/ Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: PERMIT NO.: �3�3
LOCATION: 7 INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance $,
Well separation distance _ ft.
Other wells: ft.
..Absorption Field: Total length ft.
Length of each trench $.
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/Partial
End Caps
Location/Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
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 call the Building&Codes Office
Disapproved
Last revised 1/6/05
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: 310 am/pm Depart: am/pm
742 Bay Rd.,Queensbury, 12804 Inspector's Initials: _t _
NAME: u 4 PERMIT NO.: —3v 3
LOCATION: INSPECT ON: ai
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance $.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x C
Stone Size: G�-
Piping Size Type nrr / cC
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
End Caps
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
En 'neer Report and As-Built Y N
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 call the Building&Codes Office
Q_Disapproved
Last revised 1/6/05