2005-258 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: P20050258 Date Issued: Tuesday, May 03, 2005
This is to certify that work requested to be done as shown by Permit Number P20050258
has been completed.
Tax Map Number: 523400-301-006-0002-055-000-0000
Location: 14 WESTLAND Ave
Owner: JAMES & DEANA OLSEN
Applicant: JOHN & TRACEY MERZIG
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, �d
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: P20050258 Application Number: A20050258
Tax flap No: 523400-301-006-0002-055-000-0000
Permission is hereby granted to: JOIIN& TRAC'FY NWRZ1G
For property located at: 14 WESTLAND Ave
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: JOHN& TRACEY MERZIG
14 WESTLAND Ave Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
STONE INSTALLATIONS
14 WESTLANDS Ave
OTTEENSBITRY_ NY 12804-0000
Plans&Specifications
2005-258
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday, May 02, 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 own )Juke May 02, 2005
40
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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:
File Permit No.
Tax Map No.
Fee Paid
—
Owner's Name: J0 7—
.................. ............................................................................
Address: lWe 4i4Z
2. INSTALLER'S NAME 114 Ile PHONE NO. 7
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, T-
1980 or older x 150 gal/bdrm = t fij�j
1980- 1991 i x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes no RECEIVED
Spa or Hot Tub Installed yes no*_
APR 2 9 2005
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
TOWN OF QUEENSBURY
Tanosiaphy SoaLL-ttire Ground Water Bedrock or Impervious ter Supply
lat an at what depth at w4at depth municipal
--ro-gi-ng 4oam AlAAf- fe
et 4/,* feet
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is_ft.
other
Percolation Tegr (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: XA�/ gallon (min. size 1,000 gal.)
42 .
Tile Field: each trench � ft. Total System Length: OD ft.
Seepage Pit(s): number of size of each: _ft. by t.
_f
Size of Stone to be used: # depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each:_gallons TOTAL Capacity: gallons
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 i
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 o7;wn,of Queensbury Sanitary Sewage Disposal Ordinance.
_99-naturAQresponsible person Date
' 'row-11 of (Imumalntry
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: aWpeqpart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initial
f,
NAME: Z C' PERMIT NO.: f
LOCATION: INSPECT ON: - - s5— r S
RECHECK: _ n f
Comments and/or diaarim
Soil Typ Cla
Type of Water:tMunicipap Well Water
Waterlines ara ' istance ft.
Well separation distance ft.
Other wells: ft 1 r
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone CrgAT4>f
Seepage Pits: Number
Size: x
Stone Size:
Piping ize Type
Building to tank / N
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
End Caps
Location/Separations
Foundation to tank ft.
Foundation to abso tion ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of Sys m on Property:
Front ea Left Side Right Side
Middle Front Middle Rear
System Use Stati
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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DAIE
TOWN OF QUEENSBURY BUILDING DEPARTMENT ,
►.b on our limited examination,
r: IJILDINU ,omppHance wi
not be construed as indicating the
plans and specifications are C�QIs
i: r=VIEWEM�� compliance with the Building
of-New York State.
OATS --