2001-305 � t TOWN OF QUEENSBURY
AW742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010305 Date Issued: Friday, May 18, 2001
This is to certify that work requested to be done as shown by Permit Number P20010305
has been completed.
Tax Map Number: 523400-301-012-0002-027-000-0000
Location: 368 DIXON Rd
Owner: CONNIE CASEY
Applicant: CONNIE CASEY
This structure may be occuga'a a WRATH
By Order of Town Board
Septic Alteration Residential TOWN OFF QU/EEENSBURY
Director of Building&Code Enforcement
11 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010305 Application Number: A20010305
Tax Map No: 523400-092-000-0001-001-022-0000
Permission is hereby granted to: PHIL WALWRATH
CONNIE CASEY
For property located at: 368 DIXON 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: CONNIE CASEY Septic Alteration Residential
368 DIXON Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name / Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans &Specifications
BP 2001-305
SEPTIC ALTERATION AS PER PLOT PLAN AND SPECIFICATIONS
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 17,2003
(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 Queen, uryA; Thu day,May 17, 2001
SIGNED BY _ c ,/ 4(`/f'V k� for the Town of Queensbury.
Director of Building o nforcement
TOWN OF QUEENSBURY
4,0 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010305 Application Number: A20010305
Tax Map No: 523400-092-000-0001-001-022-0000
Permission is hereby granted to: PHIL WALWRATH
CONNIE CASEY
For property located at: 368 DIXON 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: CONNIE CASEY Septic Alteration Residential
368 DIXON Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY. NY 12804
Plans &Specifications
BP 2001-305
SEPTIC ALTERATION AS PER PLOT PLAN AND SPECIFICATIONS
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 17, 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 ToagsCQueensba ry; Thursday,May 17,2001
SIGNED BY / 1� .� 'ti/ for the Town of Queensbury.
f.
Director of Building :oP ode t: forcemeat
•
•
Application for Permit—Septic Disposal System
•town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
- Location of installation: ��'3(5- h-i'Mit-' ,, d - Ofrice Use
No. 9 •. File Permit Nog-3
Tax Map
• Owner's Name: arl
17,-/C Fee Paid `�` .
• . Address: a t-e- /),- ---3
kr (.vd
REcElvED • - - . .
2. • INSTALLER'S NAME : 57 , ei J-.1l l' 1 C lgij1%1 A809 i`F.19• 1
3. RESIDENCE INFORMATION ►.it. , i .., :�.•-, ,
.•(circle year of dwelling, indicate #bedtTo`�m .�)�nd-�mu'lt:�ipl}j-fl.i��f .
bedrooms with applicable gallons per bedroom- OtgaVoia rdai:�f 5w)
. Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older 3 x .150 gaVbdnn = ~�
1980— 1991 x 130 gal/bdrm `�
1991 —present x 110 gallbdrm
. . Garbage Grinder Installed . yes _ /i.no K
Spa or Whirlpool Installed yes— / no -7 .
4. PARCEL INFORMATION: (circle applicable information&indicate measurements) •
op. t• . .t&c tl►° t!!t9 Q.round Water_ ocdrock.9r iviPerYivUs M.gerkal %_omit strc_..`.-itor_Supply
Flat ra , at ► hhrr i emit . - n/Nhai le th . ' nrtrrriclp
ling loam y� ' Meet
Steep slope . clay l
if well; water supply .
___%slope other from any septic-system
depth: . . absorption is fl.
•
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 amovcd subdivision). Add 250 gallons to the size
• of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: /9 6O.gallon (min. size 4,000 gal.)
• Tile Field: each trench ft. Total System Length: fl.. .
•
Seepage Pit(s): .number of. size of each: rfl. by Kfl.
•
Size of Stone to be used: ll 9 ' / 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 Quoonsbury, 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 those and all
• requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
5—i, --)6907 '
3 ature of responsl leperson Date
e —.
\ . `.--53 -- 19:07()
Septic Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/prttv)$part: /i/„fir, '7_'_�am/pm
742 Bay Rd.,Qu`e-e�nssb�u'ry,NY 12804 Inspector'sl Initials:N ��LL((-
PE
LOCATION: �l� 2I�Cd INSPECT ON: --� 3
RECHECK:
e Comments and/or diagram
Soil Type: San' /Clay
Type of Wa Municikal/Well Water
Waterline sepa 'on ditance ft.
Well separation distance ft.
Other wells: _ ft.
Absorption Field: Total length ft.
Length of each trench - ft.
Depth of trenches ft.
Size of Stone -et__
Pits: Number Ali _ Q
Size: x V _
Stone Size: t -
Pipingi Sjge Type
tx? SPZ/1I(f
Building to tank
Tank to Distribution Box J^ 604 "e5
Distribution Bo ield/Pit IA. 0
Opening Sealed Y NI Partial
Location/Separations ( �
Foundation to tank
Foundation to absorption _ ft.
Separation of Pits Z ft.
Conforms as per Plot Plan N
Location of System on Pro. • y:
Front Rear eft Sid; Right Side
Middle Front Middle Rear
System Use St s:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L\SueHemingway\Building.Codcs.Inspection.FORMS\Septic Inspection Reportdoc January 28.2003
TOY( OF QUEENSBURY c2 31(D —
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY121104
(518) 161-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ?/jii ti& `erne-//—
(71
Locations '3(D7 (J'ic9�'— 11�y//—2�
Date 7/ Ig/di Permit N /J1J
SOIL TYPE: Sand-Loam-Clay-
Results of Perco ati . Test-
(if applicable) 'ate inute/Inch
TYPE OF SYSTEM:
ABSORPTION FIE 1: Tot.1 Length
Length of each .rench
Depth of trenche-
Size of stone
SEEPAGEPITS: /
Si - fze � B ft.
Stone size
PIPING: 3 rSiz Type
Bldg. to Tank C s ^-
Tank to Dist. Box H''
Dist. Box to Fiel ./Pit L[
Openings Sealed? Yes No 'artia
LDCATION/SEPARATIt S: S feet
Foundation to Tan
Foundation to Abs.rption feet
feet
Separation of Pit
Conforms as per P1 .t Plan Yes No
LOCATION OF SYSTE ON PROPERTY:
(circle one)
Front - Rear - 411 - Right Side
Middle Front - Mi . . - 'ear
COMMENTS:
ej, /( 4- SI4 �F
/Q4 sir>) L/ 900 2
SYSTEM.USE APPROVED: YE NO
Arrived: Zr3'
Departed:
Building Inspector
TO* OF QUEENSBURY /4
34
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY_12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Gt-1-
Location 3 %)
Date _____J/ Permit # 2e0/_of
SOIL TYPE: Sand-Loam-Clay-
Results of Percola 'on Test-
(if applicable) R. - Minute/Inch__
TYPE OF SYSTEM:
ABSORPTION FIELD: I . :1 Length
Length of each tre
Depth of trenches
Size of stone V
SEEPAGE PITS: umb?r-
Size - ft. - f----t
Stone size
PIPING: Size ype
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/P't
Openings Sealed? es Ep art:a
LOCATION/SEPARATIONS
Foundation to Tank
Foundation to Absorp — feet
Separation of Pit ion feet
Conforms as per Plo - Plan _ feet No
LOCATION OF SYSTEM I. . PROPERTY: s
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
Gde,./ Geer A6Li ait Stt
SYSTEM USE APPROVED: YES Cep/
Arrived: till
Departed:
Buf]ding Inspector
TOW OF QUEENSBURY ,rye _ ,
BUILDING & CODE ENFORCEMENT ,1l(JY���/�jj,j,���,
742 Bay Road ,�\
Queensbury NY 12804 {l�la�
(518)761-8256 4y(4
SEPTIC DISPOSAL SYSTEEMaIINSPECTION \
Name ° T\ � WO)Ne"0 \h
Location 314A CD) $m \
Date L —3C ap)Pennit #
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 artia
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:
La e 4...,1 Ar Aka,
12 - r CO) IrY /0.4r
SYSTEM.USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector
insPeCW
Building
- e- —_
- '�ie,zendre
Meets-rrchas ho me:ye s frees, fences,etc.,
-- - -- - - _---- �` Y Preseutthatrhave S
@J>' +rnLn this document.f-also-re
- ersanall measured the distances setfortheo-thediaram"- — --
SIGNATURE - LATE _
exI1I f
_ „do 5
tcc,
4.1
* ,4 , ti
- � Qr'v�E ``FBURY gxla BUILDPto1G & d EPT. --- --
- _. REVIEWED BY ---- --�
_. .. DATP
_. -.. cc
C!"
• .l
c -
V
� r
Urt