2003-962 TOWN OF QUEENSBUIRY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community'Development-Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20030962 Date Issued: Thursday, November 20, 2003
This is to certify that work requested to be done as shown by Permit Number P20030962
-has been completed.
Tax Map Number: 523400-316-013-0001-011-000-0000
Location: 31 BARDIN Dr
Owner: JOSEPH C BARDIN
Applicant: JOSEPH C BARDIN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Co ' Enfo went
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030962 Application Number: A20030962
Tax Map No: 523400-316-013-0001-011-000-0000
Permission is hereby granted to: JOSEPH C;BARDTN
For property located at: 31 BARDIN 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. i Type of Construction Value
Owner Address: JOSEPH C BARDIN
31 BARDIN Dr Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans.&Specifications
2003-962
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday, November 21, 2004
(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 Town of Queensbury; Thursday, November 20, 2003
SIGNED BY for the Town of Queensbury.
irector of Building Cod nforcement
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: �� e �JeL4— .
......................................................................................................................................:
Address: r y-J r
2. INSTALLER'S NAME :r��
e ./D r2 i,�'�/' PHONE NO.
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 x 150 gal/bdrm CI
1980— 1991 x 130 gal/bdrm = ��
1991—present x 110 gal/bdrm = sd�V 2 ® 2CC3
Garbage Grinder Installed yesTOWS OF O�c �g1319'
Spa or Hot Tub Installed yes_ 13llILD1N(�AEG ODI
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Top—ogrgphy Soil Nature Ground Water Bedrock or Im ervious Material Domestic Water&ppl
Fl sand. at what depth at what depth munzczpa
Rolling loam feet feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
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.
,e�
Septic Tank: /V2ff�'gaallon (,m .)
rin. size 1,000 gal
Tile Field: each trench�? �' 7 f I Total System Length: ! Zft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: r x
Alternative System:/l�/ /(Aa`�cj 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
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 Queensbury Sanitary Sewage Disposal Ordinance.
. - 2
Si nat re f responsible person Date
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: e a I
742 Bay Rd., Queensbury,NY 1,2804 Inspector's Initi s: 2 �
NAME: V'� P IT NO.:
LOCATION: SPECT ON: `\- �� -(�
RECHECK:
Comments and/or diasram
Soil TYR Sa /-Clay
Type of Y'atir, unicipal ell Water
Waterline separa` ance ft.
Well separation distance ft.
Other,wells: ft.
Absorption Field: Total length I ft.
Length of each trench G>A
Depth of trenches ft. �
Size of Stone
-Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank . h •
Tank to Distribution Box
Distribution Box tp,-]Vield/Pit —
Opening Sealed• Y/ /Partial "J
12
Location/Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Location of System on Property:
Front Rear Left Sid ght Side
Middle Fro Middle Rear
System Use S tus:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
LASueHeraingway\Building.Codes.[nspection.FORMS\Septic Inspection Report.doc January 28,2003
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BUI DINg AND CODE.
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BUILDING
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REVIEWED 13Y r
DATE
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"I have seen or observed, or believe I saw evidence of,
all nbJeCtS suchas hoses, aVeilS, trees, fences,
Sh'.•m on i1-m document. I also represent that I have
scr�iR� n� , r,d A;� distars set forth on the diagram."
SIGNATURE -DATE
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