2005-282 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: P20050282 Date Issued: Tuesday, May 17, 2005
This is to certify that work requested to be done as shown by Permit Number P20050282
has been completed.
Tax Map Number: 523400-296-012-0001-013-000-0000
Location: 32 BAYBERRY Dr
Owner: DOUGLAS COON
Applicant: DOUGLAS COON
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 /J
property owner of the responsibility for compliance with Site Plan, ✓Q(
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: P20050282 Application Number: A20050282
Tax Map No: 523400-296-012-0001-013-000-0000
Permission is hereby granted to: DOI ICTLA S COON
For property located at: 32 BAYBERRY 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: DOUGLAS COON
32 BAYBERRY Dr Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-282
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, May 06, 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 Tpwro.Qf Queen ury; ri ay, May 06, 2005
SIGNED BY C for the Town of Queensbury.
Director of Buildin Co nforcement
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Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 7"61-8256
1. OWNER INFORMATION: .................................... ....................
// Office Use
Location of installation: r
—T File Pe�mit NO. f U
Tax Map No.' �,/2/
Fee Paid
Owner's Name: Tie<<< As l,! C111 iti
Address: r D� �' �IZZ
/a
2. INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of SS
bedrooms with applicable gallons per bedroom to equal total daily flow)
j
Year of House: No.of Bedrooms x Cgn utation = Total(Daily Flow
1980 or older x 150 gal/bdrm =
1980-1991 x 130 gal/bdrm = 5" 2
1991 -present x l gal/bdrm =
Garbage Grinder Installed yes_ / no �,vD
Spa or Hot Tub Installed yes— / no ✓ R�C
IM Y �) 3 2t10� 1
4. PARCEL INFORMATION: (circle applicable information&indicate me' ss
TAN OF QUEENSBpURY
14"araDhv Soil Nature Ground Water Bedrock or Impervious M iN ater Su 1
Flat sand at what depth at wh depth municzpa
oiling loam i0 "feet &, feet well
Steep slope qc1a if well; water supply
^%slope from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: 1-%5 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: /-)-r0 ' gallon(min. size 1,000gal.)
Tile Field: each trench�ft. Total System Length: ft.
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Seepage Pit(s): number of size of each: ft. b� ft.
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Size of Stone to be used: # ! depth or thickness feet,
Bed System Size: x
Alternative System: e ('length and/or size AM r
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: I 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-, 9 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 of Queensbury Sanitary Sewage Disposal Ordinance.
th wn
Signature of n6sponsibie person date
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ /Depart: am/pm
742 Bay Rd., Queensb�u-try,NY 12804 Inspector's Initials: t/
NAME: CDC PERMIT NO.:
LOCATION: l dZ 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.
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 Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as_per Plot Plan Y N
Location of System on Property:
Front Rear Left Side Right Side
Midd/FroMliddle Rear
S stem Use Sved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
LaSueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
Septic Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p Depart: pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: '
NAME: PERMIT NO.:
LOCATION: �, {Sx?.� � i7,��. INSPECT ON: _
RECHECK:
Comments and/or diagram
Soil Type: San Cla
Type of Water- ipal Well Water
Waterline sep4ration dist ce ft.
Well separation a ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone L
Seepage Pits: Number
Size: x
Stone Size:
Piping Si T e
Building to tank leor
Tank to Distribution Box K
Distribution Box tq Field/Pit_ I
Opening Sealed: Y/N/Partial
End Caps
Location/Separations
Foundation to tank ft.
Foundation absorption ft. /
Separation off Pits ft. 604066� 3� 'g 5W4�
Conforms as per Plot Plan N
Engineer Report and As-Built Y N
Location of System on Property:
Front ear Left Side 'ght ide
Middle Front Middle Rear
System Use Status:
roved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 116105
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: lr t J am/ mI Depart: _am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: ' e,
NAME: , PERMIT NO.: Q;j.Z3'2-
LOCATION: ? 2- ;�� 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.
Absorption Field: Total length ft.
Length of each trench ft. cvmow.,,-p i 4
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size:
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 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 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
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I have seen. or observed, or believe I saw evidence of,
all ob,er,,ts such as houses, wells, trees, fences, etc.,
s h�uw r on this document. I also represent that I have
y r4t
person rn asured the distances set forth on the diagram."
S NA LI R E DffE—
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TW
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BUILDING
REVIEWED BY
DATE