2003-682 OF QTOWN UEENSBURY
742 Bay Road,Queensbuty,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761.8256
CERTIFICATE.OF COMPLIANCE
Permit Number: P20030682 -,Date:Issued: Tuesday,August 19,2003
This is,to,certify.that work requested to be done as shown byPermitNumber. : P20030682=".,,
,.,. has been completed,
Tax Map Number: :.523400.302-014-0002.082-000-0000
3
Location: 87 DIXON Rd
Owner:.. PAUL BRICOCCOLI-JR
9
Applicant: PAUL BRICOCCOLI JR .
This structure may be occupied as a:
By Orderof Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code gnforc4ent
TOWN. OF IQUEENSBURY
742 Bay Road,Queensbury;NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030682 Application Number: A20030682
Tax Map No: 523400-302-014•-0002-082-000-0000
Permission is hereby granted to: PAUT;BRTCOCCOLT JR
For property located at: 87 DIXON Rd
in the Town of Queersbury,to coristruct'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: PAUL BR.ICOCCOLI JR: -
87 DIXON Rd Septic Alteration Residential
.Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address •..Electrical Inspection Agency
SANITARY SEWER
DAN DREI LOS
PO BOX 224 a `
GLENS FALLS NY
Plans&Specifications
2003-682
SEPTIC ALTERATION AS PER PLOT PLAN'SPECIFICATIONS
$25.00 PERMIT FEE PAID=THIS PERMIT EXPIRES: Thursday,August 19,2004
(If a longer period is required,an application for an extension musf,be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To n of eens a ay,August 19,2003
SIGNED BY for the Town of ueensb
Q 'may
Director of Building&Code Enforcement
Application for permit--Septic Disposal System
Town ofQueensbury 742 Bay Road Queensbury,NY 12804 (S18) 761-8256
1. OWNER INFORMATION:
, ,M..
�.-.�..._..._..._.....,., Officece Use
Location of installation: D'I'vo0 Q j
Tax Map No. File rera�it 147.
t^,(
• Fee Paid \
Owner's'Name: d�"t� f G e G O�. ,�
Address:
__... _...._....._ . ....._..._....__ __.....—....._.........
2. INSTALLER'S NAlVI>1Lzu,try.. PXIONE NO. ! 9d -7A:( 7
j
3. RESIDENCE INFORMATION: (circle ear 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 FIovcv
1980 or older x 150 gal/bdnn =
1980- 1991 Z/ x 130 gal/bdrm ; Zm
1991 -present x /l 10_gal/bdrm =
Garbage Grinder Installed yes_ / no / ''
Spa or Hot Tub Itstalled yes i / no ,, �� F
t ._
4. PARCEL INFORMATION: (circle applicable information&indicate measurement%U G 1.8 2003
h ature Ground Water Bedrock Qr Im ervious Material D cstie'Water sunl3ly
Fl a_ at what depth at what depth 1�W�t
aping oam feet feet �at! 1 a�......~»8. r.
Steep slope - clay if well; water supply
`/o slope other from any septic-system
depth: absorption a' ft.
other
Percolation Test: (7'o be completed by licensed professional engineer or architect)
Rats: minute per inch
i y
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional,engineer or architect(uixless installed in a Plauning Board approved subdivision), Add 250 gallons to iHe size
of the septic tank and leach:field for each Garbage Grinder,Spa or Whirlpool Tub.
la" id�r�.rl�
SCptic Tank: gallon(min. size 1,000 gal,)
'rile Field: each trench-!�ft. Total System Length:o
Seepage Pit(s): number of size of each: ft, by ft.
Size pf Stone to be used: # l depth or thickness feet
Bed System Size: ,x
Alternative System: length and/or size
5. 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. SIGNATUR.E &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 hav ea regulations vvitli r\es ct to this npplication.and agree"to abide by these and all
rcg ements o the Town of Que rn b Sanit ewage Disposal Or C.
I
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l 't�,
ig re of'res Bible person Dttte
Vvy S'P:eT An T_ rnn7/Tnit.n
COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC, 0
Main Me 176 Doe Run Road of Manheim, PA 17545
MUNICIPAL CERTIFICATE a ELECTRICAL APPROVAL
Permit No. Cut-in Card No.##1#.4He#####a Iloo a#41#e Hf####
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Installation Consistingof of,SO t4444fi4f/#•toot#4fii#ffi#iMfff#fmmIfff#f•fifif i ff N•.#fi.f#f#i�#}if.ioekpa
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The conditions following governed the issuance of this certificate, and any certificate previously issued i
cancelled: -
This certificate only covers the electrical equipment and installation conditions as of date, Upon th
introduction of additional equipment or alterations, application shall be romptly Made for inspection.
Inspectors of this Company shall have the privilege of makin ins ections at any time, and if il
rules are violated, the Company shall have the right o r ke hi ce ' scat
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Date,,, Huu1HH#HHf#eHHfeif#H.lfiff4.fi1##r INSPECTOR #ff #tuH1 #411fi •441f#644f111#HHu##ftnfafl.fun#..fH*r�1i1N1#11•�ft/gf4f1N4}Hi
Mpmhpr N.F.P A.. 1.�.F.�.
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.,Queensbuiy,NY 12804 Inspector's Initials:
}
NAME: PERMIT NO.:
LOCATION: 1 X INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: a J Lo Clay
Type of Water: Munic al/Well Water
Waterline se ara ' distance ft.
Well separation distance ft.
Other,wells: ft.
Absorption Field: Total length ;Z- ft.
Length of each trench ft.
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Siz Type
(� Building to tank
✓ Tank to g U@* t
Pii4ibttti&n44ex to Field/Pit
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Se aration of Pits ft. - r
Conforms as per Plot Plan Y N
Location of Sy Property: o
ftq.O /0-7 Front VeaLeft Side Right Side
Middle Front Middle Rear
System Use State <--,
Aoved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\SueHemingway\Building.Codes.inspection.FORMS\Septic Inspection Report.doc January 28,2003
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, I have seen or observed,or believe I sa�—�--......._�1
all objects such as houses, wells,tr s,fences,evidence of,
,own on this docu s,etc.,
e ,I also re esent that I have
ers ally meascr th dis c
set forth on ;e diag am,,r
SIG�ATU �
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