2005-952 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: P20050952 Date Issued: Tuesday, December 27, 2005
This is to certify that work requested to be done as shown by Permit Number P20050952
has been completed.
Tax Map Number: 523400-309-011-0001-055-000-0000
Location: 5 THOMAS St
Owner: FLOYD &VIVIAN DUMAS
Applicant: FLOYD &VIVIAN DUMAS
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,
Variance, or other issues and conditions as a result of approvals by the Director of Bu ding&Code Enfo emen
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: P20050952 Application Number: A20050952
Tax Map No: 523400-309-011-0001-055-000-0000
Permission is hereby granted to: FT,OYD & VIVIAN DI TMAS
For property located at: 5 THOMAS St
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: FLOYD & VIVIAN DUMAS
5 THOMAS St Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
MORNING STAR
Plans&Specifications
2005-952
SEPTIC ALTERATION
sandyk - 12/21/2005 4:13:27 PM
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, December 23, 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 Quee ury• r' ay,December 23, 2005
SIGNED BY for the Town of Queensbury.
Director of Building&Co Enforcement
' OFFICE USE ONLY '
5S
00 TAX MAP N0. PERMIT N N_%)� ERMIT FEE 0 ;
/ ,
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. ff�J ll
OWNER: � 1 t5f 1�,L„_ 60 4- INSTALLER: Z221 2�-
ADDRESS: S— �_�y w y _s_�, ADDRESS: s�2✓n�c-
PHONE NOS. ?% 2 7 �+ I PHONE NOS. 7 73 a 2q C) 7 q u2_5 3-k — L
LOCATION OF INSTALLATION:
........................................................................................................ ....................................................... ........................... RESIDENCE INFORMATION
NO.OF s .
€ YEAR BUILT X i COMPUTATION= _ ? TOTAL DAILY FLOW
BEDROOMS
<. ?...........:..........................................................................:.........
1980 or older J i X 150 gallon per bedroom; ? INSTALLED?'
'� .. DERV'
............................_................. .... ....................;.
1981 -1991 1 X 130 gallon per bedroom = 's U................................................r...............................,,.............i. ....;.........................................................................;....................................,................................................I INSTALLED?.
PA OR HOT TUB
1992-present X 110 gallon per bedroom
................................................:...........................................................:..........................................................................i...........;..........................................................................
PARCEL INFORMATION: R h C,� Ir'D
✓ TOPOGRAPHY: FLAT ROLLING__X STEEP SLOPE %SLOPE
DEC � ' 2005
✓ SOIL NATURE: SAND--& LOAM CLAY OTHER
TOWN UF�:...,c:�t�iSEi11�Y
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS- IATER`IALti`aAT_
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL_ WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS 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: Mror--) GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH :5 FT. x`/
✓ TOTAL SYSTEM LENGTH:AFT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT. ��.�Ca. �•
✓ 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 TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY. GAL.
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
'.! APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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 QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. . codes@queensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.gueensbury.net
Signature of Person Responsible Date
Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury,NY 12804
Septic Inspection Deport
Office No.(518)761-8256 Date Inspection req e'
Queensbury Building&Code Enforcement Arrive: i p Tart: a m
742 Bay Rd., Queensbury,NY 12804 Inspector's Initia s
NAME: �� �' P IT NO.: J
LOCATION: �j (� S .�_ SPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: San oa Clay
Type of n' p2r Well Water
Waterline separktionOtKtance -p
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone Md
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank U" hC,A q fj
Tank to Distribution Box 01N
Distribution Box i d/Pit W,
Opening Sealed: Y /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 fiddle Rear
System Use S tus:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
Community Development Office
Town of Queensbury • 742 Bay Rd.
Queensbury, New York •12804 PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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