2011-166 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: P20110166 Date Issued: Monday, May 09, 2011
This is to certify that work requested to be done as shown by Permit Number P20110166
has been completed.
Tax Map Number: 523400-309-009-0003-064-000-0000
Location: 54 MASSACHUSETTS Ave
Owner: ANDREW& HELEN CORDIALE
Applicant: ANDREW&HELEN CORDIALE
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 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: P20110166 Application Number: A20110166
Tax Map No: 523400-309-009-0003-064-000-0000
Permission is hereby granted to: ANDREW&HELEN CORDIALE
For property located at: 54 MASSACHUSETTS 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: ANDREW&HELEN CORDIALE
54 MASS. Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC&DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans&Specifications
2011-166
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,May 03,2012
(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 eensb T s y 03,2011
SIGNED BY 47 for the Town of Queensbury.
Director of.Building&Code Enforcement
7�
� !; Revised 4/14/20110
I Q qV
OFF�QUSE ONLY m/� QUl
TAX fviAP N7- ? 3 �J PERMIT NO. _PERMIT FEE = - _ ,....
�OWi� C.. �i t'.;'-SSURY
&
APPROVALS: ZONING TOWN CLERK BUILDING CODES
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PER MIT.
OWNER: A ti// aAi / , c ( n
ADDRESS: ry A L ADDRESS: �4 !+ t,--cr Pr 'y
PHONE NOS. �d PH E NOS
LOCATION OF INSTALLATION: 5 S�
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL >� WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS 4 PER MIINUTE PER INCH[mpi]
(Test to be c mpleted 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).
TANK SIZE: �( 1 GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
` each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length r 4 ft. Each trench _X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑HOLDING TANK SYSTEM Total required capacity? Tank size? IV Number of tanks?,dA
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 Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sew a Disposal Ordinance. ) codes(cDgueensburv.net
S /)/do /l/ VISIT OUR WEBSITE FOR MORE INFORMATION
Sig ure of Pe on Responsible Date www.aueensbury.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: _ am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: /7
ell,4 F
NAME: PERMIT NO.: 1611) 1
LOCATION: . 2 _ At
INSPECT ON:
RECHECK:
Comments and/or diagram
Soil T , / Loam/Clay
T of Water: nid Well Water
Waterline se ration distance
Well separation distance2 ft.
Other wells: A ft.
Well Casing Length 50'+/- Y N N/A
150'to well r uired if NO
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches . ft.
Size of Stone `L
Seepage Pits: Number
Size:
Stone Size:
Piping Size Typey
Building to tank � ��
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: N
End Cap N
InletjOutlet Pipes&'Baffles N Cam.
Manholes 12"or less below grade _ N
rovide extension collar if Yes
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits
Conforms as per PI
En ineer Report aQ As-B ' � Y
ETU Maintenance Contract Y_provided
-'L—Z7-F—W!4
Location of System on Property:
Front Rear Left Side ight Side Middle Front Middle Rear
stem Use Statids.
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
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QUEENSBURY, NY 12804 Date Number
TEL# (518-792-1316) 02/02/11 18878191
To: FAX# (518-792-1335)
SE_TTC .1 DRp.,IN
SAME
2 LOWER WARREN ST 3 HIGHLAND AVE
QUEENSBURY NY 12804-3814
r QUEENSBURY, NY 12804
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103-7 -' CLOSET BOM Writer DateDate Req
02/02/11
Qu �teci By: FRED MARCHALAND PAGE I OF 1
------
,.-ant_•_y- Descri-ption
------ Net Price Exten -------------------------- __________
1 BOWL ELNGTD HDCP ECO DRAKE ---*
TTOC744ELOJ � T14.700 114.70 { 1)
- (37� ,�Of1).
TTOST743EOJ 66. OG 66.70 { 2)
1 * TLT SEAT EL CF6JC PLS. WHT3724�1}r ,
SEA130ECOOO 22.000
(1834) 22.00 ( 3)
_
BREAK-ST: 203.40
BOWL ELONGATED ECO DRAKE
TTOC744E01 9 89.400 89.40 ( 5)
?- * TT TN E � (3723�9)
TLT TN CO DRAKE EM-�,X CO.T. 1.2 66.700
66.70 ( 6}.
(j 72401.)
"- TLT SEATEL CFrnIC PLS WHT 22.000 22.00 (SEAl-30EC000 (1834) 7)
BREAK-ST: 178.10
(ROUND BOWL)
i k TLT BWL DRAKE RF 12"R COT 70.670 70.67 ( 10)
TTOC743EOJ (255465)
TLT TNK ECO DRAKE EMAX.COT 1.2
TTOST743E01 66.700 66.70 ( 11)
(372401)
!• TLT SEAT R CFWC PLS MIT 16.500
SEA3EC000 (1823) 16.50 ( 12)
BREAK-ST: 153.87
Sub Total: 535.37
W Tax: 37.48
6 n �•� Total: 572.85
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