2007-757 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20070757 Date Issued: Friday, December 21, 2007
This is to certify that work requested to be done as shown by Permit Number P20070757
has been completed.
Tax Map Number. 523400-295-010-0002-002-000-0000
Location: 25 BONNER Dr
Owner. CHURCH OF THE MESSIAH
Applicant: CHURCH OF THE MESSIAH
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Boat
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the /f
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& de E oreement
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: P20070757 Application Number. A20070757
Tax Map No: 523400-295-010-0002-002-000-0000
Permission is hereby granted to: CHURCH OF THE MESSIAH
For property located at: 25 BONNER 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: CHURCH OF THE MESSIAH
296 GLEN St Septic Alteration Residential
GLENS FALLS,NY 12801 Total vane
Contractor or Builder's Name/ Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2007-757
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, December 18, 2008
(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 a!�
December 18, 2007
SIGNED BY Quee u for the Town of Queensbury.
Director of Building&Code Enforcement
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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
PERMIT.
OWNER: t t 'C INSTALLER
ADDRESS:l - / 1 ADDRESS: f� t� �4 c' ✓--
PHONE NOS. PHONE NOS. f t-r ^� 7� ' Q/
LOCATION OF INSTALLATION: . L'01fiA),',- t)
..............._..,.........................................................................................1. .............................................................................. ..............-.................................................... .
:••• •••; RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS { X COMPUTATION= i = TOTAL DAILY FLOW
}................................................................... ..................................................................................................;...........:.............. ......................................................; GARBAGE GRINDER
I 1980 or older........................,.?...................IL X...'.......1.50,gallon per bedroom ....�... <✓� .7..........................,.............. INSTALLED?
i.........................._........... ....... .........................................
1981 •1991 ; ( X i 130 gallon per bedroom ;• = E SPA OR HOT TUB
.................................,........................,................,...........1.........................................................,...............;...........t..............................................................,...........
,
1992-present i X ? 110 gallon per bedroom i = ! INSTALLED?
:............ a_..... ..................................1
..........;..........................................................................1...........L.............................................................I...........
PARCEL INFORMATION:
✓ TOPOQRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ $OIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCKAMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL _ WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. 1
✓ PERCOLATION TEST: RATE IS r PER MIINUTE 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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder,spa or whirlpool tub.
✓ SEPTIC TANK: ,-' C GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ S{ZE OF EACH 0, FT. X /` ..- FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS = FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(if required) NO. OF TANK; /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
• ,,,,,,,,,,,,,,:,,.,,,.,.....,....,,.,.a,.u+.,,,,,..�.,,,...,,..,.,.,,,.•,,....,,,,.>...,,,...,. ,,:a.......,.,.a,...,.,,,,.,..,��.,..,,,,,,.,a..,,,,,,,,,,,,,,:,u.,a,,..•,•Y
I; NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL 4ORK MUST BE INSPECTED BY A TOWN
t,, APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE-, REVIEW LIST PROVIDED.
il..:..........•........,.,...,.,_;.,..•:•..,•....:.,.:.,.:.....:.......,.........,•....,.,.,...,.,...:.,...:...,.:.,...,...,.,.,.,..•,.:.......,...,.,.,.,•,.,.,.,..•:.,.....,.,.,...,...,.,...,...,.,...,.,.:.,.;_;..............,.,.,•,.,...,.:.,.,.:.:.............................,.,.,.,.,.,.................,.,...,.:.:.,.,.,.:..............
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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 gUEST10NS? CALL 761-8256 OR EMAIL
agree to abide by these and all requirements of the Town of codes�aLLensbury net
Queensbury Sanitary Sewage Disposal Ordinance.
E
VISIT OUR WESSITE FOR MORE INFORMATION
t m .aueensburv.net
;5- C
Slgnature`V Person Responsible Date
;•--•� Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
12� -71
Septic Inspection Report
Office No. (518)761-8256 Date Ins- .
Queensbury Building&Code Enforcement Arrive: part: =0D a
742 Bay Rd., Queenssbbu//ry, NY 12804 Inspector's Initial
NAME: ( '�I�)j' OTy/; S IT NO..
LOCATION: Z5- Cam►�w�c=� Q I PECT ON,
RECHECK:
Comments end/or diagram
Soil Typd, clay
Type of Water:j,.;0uniQ&bWell Water
Waterline se ration distance ft.
Well separation distance ft.
Other wells: ft.
Abso tion 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 Bo*
Distibution Pit �t
Opening Sealed .Y N artial
End Ca
KEPT-�c�.
InMg22fts&Baffles Y N F, 5V
Location/ Separations
Foundation to tank ft.
Foundation to abso 'on ft,
Separation of Pits ft.
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 le Rear
m
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
D 7,r
Revie-wed -By:
TOWN CT %--4UEE-.NSBURY
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