2003-873 41" TOWN OF QUEENSBURY
2 Ba Road ueensb NY 12804-5902 518 761-8201
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Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20030873 Date Issued: Wednesday, October 22, 2003
This is to certify that work requested to be done as shown by Permit Number P20030873
has been completed.
Tax Map Number: 523400-308-018-0001-079-000-0000
Location: 26 SURCINGLE Rd
Owner: PETER LOSACCO
Applicant: PETER LOSACCO
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
, ;,/ —
Director of Building&Code Enforcement
•
. TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030873 Application Number: A20030873
Tax Map No: 523400-308-018-0001-079-000-0000
Permission is hereby granted to: PETER T,OSAC CO
For property located at: 26 SURCINGLE Rd
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: PETER LOSACCO
26 SURCINGLE Rd Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OITEENSBTTRY_ NY
Plans&Specifications
2003-873 •
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, October 22, 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 To of Queen ury; a nesday, October 22, 2003
SIGNED BY P 4 i ii,.‘,..,...„.
t for the Town of Queensbury.
Director of Building Code Enforcement
Application for•Permit Septic Disposal System
Town of Queensbiny 742 Bay Rood Queensbury,.NY'12804 (518) 761-8256
1. OWNER INFORMATION:
Locationvf installation: Office Use
lic-) C/A-
Tax Map No.<3.(E. )F 79J File Permit No,
Owner, .1qame: Kc 7c_ • 43, .57 (C
0 • Fee Paid
Address: . Sur C(A--4 Cr
•
2. • INSTALLER'S NAME 5 Sr -e_ . PONE NO. P2F2',:ri' FF,, tpb
_ IL
D
3. RESIDENCE INFORMATIONi (circle year of dwelling, indicate#bedroom(s)and multiply II 9/-
bedrooms-with_applicable gallons per bedroom to equal total daily j1A1 2 Q2003
TO WN Year of House: No. of Bedrooms • x Computation = Total Daily Fl 0owni
1980 or older : x 150 gal/bdnn (6
1980— 1991 x 130 gal/bdrm
1991 —present • x 110 gal/bdrm
•
Garbage Grinder Installed yes' - / no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information & indicate measurements) •
me_ taound_Wator_pedr.ock..edttiperYioms_Maleti.a 6"Y- Water Supply
emil a:7gikyrith • at;11417eptlii
oiling ;
well
Steep slope clay
if well; water supply
Kslopi other from any septic-system
depth: absorption is
• '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,-Spit or Whirlpool Tub. .2 -
Septic Tank; /0/9 0 gallon (min. size 1,000 gal.) .
Tile Field: each trench ) 6 ft, Total System Length:, . ji,
Seepage Pit(s): number of size of each: ft. by ft.
A 1 ACAbiLle
Size of Stone to be,used: II / depth or thickness j_.•
Bed SysteinSize: 1 • . -x _ •
Alternative System:•• • 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 Quoonsbtiry, any permit or approval granted which is based noon or ig orantrul iii
fyry.\\
•
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: r ✓
Queensbury Building&Code Enforcement Arrive: am/ ep : am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: PERMIT NO.: O�
LOCATION: - INSPECT ON: / 3
RECHECK: /
Comments and/or diagram
Soil Type. Sa / lay
Type of Water: unicipaj)Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length
Length of each trench ft.
Depth of trenches ft.
Size of Stone ix.) ,cbA. 4Z(4) ,
Seepage Pits: Number .
Size: x
Stone Size:
Piping Size Type
Building to tank (c.._ l ( c'
Tank to Distributio Box
Distribution Box ield/Pit ti a4
Opening Sealed: Y N/Partial
Location/Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits. ft.
Conforms as per Plot Plan Y N
Location o System on Property:
• Rear Left Side Right Side
Middle Front iddle Rear
S stem Use Stat :
Approved
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 s-en or observed. nr halipue ! ;Af Ali,denee of,
all ob ects such as-houses, wells, trees, ences, etc.,
k shown on this document 1 dist) '6r,resc ;t i ;i ! have
6 . perscnuUy measured tree distances set t'o.fry on the diagram."
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SIGNATURE DATE