2001-152 TOWN OF QUEENSBURY
FAT
742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010152 Date Issued: Friday, April 13, 2001
This is to certify that work requested to be done as shown by Permit Number P20010152
has been completed.
Tax Map Number: 523400-127-000-0011-006-000-0000
Location: 13 OHIO Ave
Owner: CARL & REBECCA CAPROOD
Applicant: CARL &REBECCA CAPROOD
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
("-- ,../P
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
wim742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
•
Permit Number: P20010152 Application Number: A20010152
Tax Map No: 523400-127-000-0011-006-000-0000
Permission is hereby granted to: CARL&REBECCA CAPROOD
For property located at: 13 OHIO 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: CARL &REBECCA CAPROOD Septic Alteration Residential
13 OHIO Ave. Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
BATEASE, GLENN
71 BIG BOOM ROAD
OUEENSBURY.NEW YORK
Plans &Specifications •
2001-152
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID =THIS PERMIT EXPIRES: Saturday,April 12,2003
(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 n of ee ft , pri112,2001
:41A
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
' Application for Permit—Septic Disposal System c:2
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 ; '
1. OWNER INFORMATION:
Office Use
Location of installation: I?j O\-\\D
File Permit No4Y j--
Tax Map No. VZ71 / 1 / (0
'CCZ
Owner's Name: P,- ECG, 1Q Fee Paid
Address: \ ? t_`)1-$1 O •ROE-A )
2. INSTALLER'S NAME : _ ( ijE PHONE NO. 792-'-7 75 7
3. RESIDENCE'INFORMATION: (circle year of dwelling, indicate'1/bedroom(s) and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of 1-louse: No, of Bedrooms x Computation = Total Daily Flow
1980 or older `3 x 150 gai/bdnn = ►-FC>
1980- 1991 x 130ga1/bdrm =
1991 —present x 110 gal/bdrm =
• APR 12 2001
Garbage Grinder Installed yes— / no
Spa or Whirlpool Installed yes_ / no ,/ TOWN OF QUEENSBURY
BUILDIhIG AlZ1D CODE
4. PARCEL INFORMATION: (circle applicable information & indicate measurements) •
•
!19 G.�vund Al.9r_._L39dCoc or paper W.S.M@44ri;ll slit Wa.ter_$upply
1' and at what depth at what depth Municipal
Rolling loam fret feet wel
Steep slope clay if well; water supply
_%slope other • from any septic-system
depth: absorption is fi.
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.
Septic Tank: 1 c oc gallon (min. size 1,000 gal)
Tile Field: each trench (oO ft. Total System Length: \ 913 F''►eJn ft.
Seepage Pit(s): number of size of each:
Size of Stone to be used: 11 / depth or thickness fret
•
Bed System Size: — 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 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.
.fit•
Signature of responsible person Date
v 1 II TT
TOWN OF QUEENSBURY •
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 •
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
•
Name r.-AR1_ ciVRD0D
Location ` 1:3 D\-\ PN E
Date ►i--l2--O\ Permit # 1--- I.II7
SOIL TYP San - oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length Fg
Length of each trenc - 1\1 4 (0%
Depth of trenches I
Size of stone 1 i;c=i . W%R,ti
SEEPAGE PITS: Num.er-
Size - ft. x ft.
Stone size
PIPING:, Size Type
Bldg. tank Fes-`1
-- Tank to Dist. .o I;; pc___
- ---- -Dist. Box to Fie d/Pit - ' I C_--b r.3V)L-XiNc4
Openings Sealed? 412* -.o Partial
LOCATION/SEPARATI 0 ' :
Foundation to T., k . 1_ feet
Foundation to Atsorption ,2,O feet
Separation of Pats _ .— eet .
Conforms as per Plot Plan a No
LOCATION OF SYS EM ON PROPER .
(circle one)
Front - Rear' - eft Side -11441.ahle
Middle Front - Middle Rear
COMMENTS:
' SYSTEM USE APPROVED: YES 0
Arrived: n
Depar- d: ;ye L.
".....e Ali '
f B - lding -ctor
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_ 1
127-11-6 '°I have seen or observed, or believe I saw evidence of,
al,, Objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have
personally measured the distances set forth on the diagram."
/0/
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127.-11-7
TOWN OF QUEE'`.',F URY
SCALE: One Inch Represents 30 Feet BUILDING �c Ii ' I% IA �'r.
REVIEWED BY _4(,/ `4/�
DATE • Jae
/
Produced by the Town of Queensbury, NY, Planning Department
I '
04/12/2001
TOWN OF QUEENSBURY
BUILDING $_CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name .c RE c? c
,
Location _ 1 d\- O RE,...
,
Date 1-1-—1 1-0\ Permit\1# 7__g11 —Ai
SOIL TYPE: Sand-Loam-Clay-
Results of.Percolation Te'st-
(if applicable) Rate-Minuhte/Inch
TYPE OF SYSTEM: 4
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches ii
Size of stone `: ;'
SEEPAGE PITS: Number- 4
Size - fit. x i ft.
Stone size 1
PIPING: )' Size Type
Bldg. to Tank •, 4°
Tank to Dist. Box 4 I
Dist. Box to Field/P%t
Openings Sealed? lees No Partial
LOCATION/SEPARATIONS:
Foundation to Tank / feet
Foundation to Absorption feet
Separation of Pits' feet
Conforms as per Pilot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - eft Side - Right Side
Middle Front Middle Rear
COMMENTS:
,i__)7_
Nc___ L_fic ,1, 3-Y--
1/__ : \
n Pam! c_ l ( b Ns)
SYSTEM USE APPROVED: YES NO
Arrived: i ,
Depar -d: t D
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:uil ,ing I rpecb
TOWN OF QUEENSBURY
BUILDING &_CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 •
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name .C'-agL. r -
Locati on 171 C) VAC)
Date 4 .-, ‘.-N Permit # ' .gr,1--16
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
LP\R
\YEA)
' �' ucnT two
SYSTEM USE APPROVED: YES NO
Arrivedl�.-� 1�j
Depa ed: tJ2c;.7C
iL-119
'Bid lding InIpect "r
127-11-6 "I have seen or observed, or believe I saw evidence of,
all objects such as houses; wells, trees, fences, etc.,
shown on this document. I also represent that I have
personally measured the dis\ \ \
tances set forth on the diagram."
iliSSE F ` ir' DATE
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127.-11-7
�' •lt ► ,w v��RY
BUILDINCa �� -T,
REVIEWED B ,,/�, Ail k
SCALE: One Inch Represents 30 Feet DATE ��iS�A
/ 3 /.
Produced by the Town of Queensbury, NY, Planning Department
04/12/2001