2005-806 TOWN OF QUEENSBURY
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4- 9 2 Iv 742 Bay Road,Queensbury, Y 12 80 5 0 (518') 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050806 Date Issued: Friday, October 14, 2005
This is to certify that work requested to be done as shown by Permit Number P20050806
has been completed.
Tax Map Number: 523400-289-013-0001-027-000-0000
Location: 47 BIRCH Rd
Owner: WALTER & ELAINE RIVETTE JR
Applicant: WALTER& ELAINE RIVETTE JR
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 P11
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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050806 Application Number: A20050806
Tax Map No: 523400-289-013-0001-027-000-0000
Permission is hereby granted to: WALTER &M AINE RIVF,TTE TR
For property located at: 47 BIRCH 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: WALTER&ELAINE RIVETTE JR
47 BIRCH Rd Septic Alteration Residential
Total Value
LAKE GEORGE, NY 12845
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2005-806 SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, October 14, 2006
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the T�Queen$ury; riday,-October 14, 2005
1 a '
SIGNED BY t_ au;/ iv( • for the Town of Queensbury.
Director of Buildin &Co Enforcement
e Application for Permit— Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: 7 % r c L rz'
File Peiuiit No.
Tax Map No. / /
� � .r fee Pai
j
Owner's Name: (r A L T L ie t t1 e-//
Address: if 7
i P R.' L 4fr i d, e
2. INSTALLER'S NAME :t✓ if) Az)e-2r �o- vi c-C__ PHONE NO.7 92 -7,2 2
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply #of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older 2- x 150 gal/bdrm = °
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes / no
Spa or Hot Tub Installed yes_ / no
4. PARCEL INFORMATION: (circle applicable information& indicate measurements)
aphy S ' ature Ground Water Bedrock or Impervious Material Domestic Water Supply
(Flat sand 1k at what depth at what depth municipal
Rolling oam feet feet well
Steep slope c ay Rif well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other 1O' 7 *,/,
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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: / 00D gallon (min. size 1,000 gal.) ��Ail v fi -�'�'`f� UN
Tile Field: each trench A/14' ft. Total System Length: it.
Seepage Pit(s): number of !r size of each: ft. by ft.
Size of Stone to be used: # 1 / depth or thickness feet
Bed System Size: x
Alternative System: ifulIA length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
i
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON(please read)
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. l
I have read the regulations with respect to this application and agree to abide by these and all requirements of
thewn of ensbury S ita ewage Dis.o-,1 Ordinance.
�� t /o /o�
S gnature of res nsible person ate
IVYk
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
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Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
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Septic Inspection Report
Office No.(518) 761-8256 Date Inspection re. est r; -'ved• 10 l( o a
Queensbury Building&Code Enforcement Arrive: . p D-.art: = am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials.
NAME: _` , � •4 IT NO.: —80(7
LOCATION: oil 7 I re jk PELT ON:
RECHECK:
Comments and/or diagram
Soil Type . J'Loam/Cla
Type of r: Municip Well Wate
Waterline separation dist nce ft.
Well separation distance - 1-0,,NA.... —TO 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
Stone Size:
Piping ^ Size Type
Building to tank ;! 6C-14 LID
Tank to Distribution Box by
Distribution Box to Field/Pit _
Opening Sealed: Y/N/Partial
End Cape
Location/Separations
Foundation to tank $ i ) ft.
Foundation to absorption 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 i t Side
Middle Front Middle Rear
System Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 1/6/05
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REVIEWED BY ___ __ i_ VAd If
DATE _ _____42 pp _ 8°
THIS PLAN TO 1:.‘E ON
PROJECT SIT: AT
ALL TIMES F •R
THE DURATIO OF
CONSTRUCT ON
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