2001-530 TOWN OF QUEENSBURY
Fora742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010530 Date Issued: Wednesday, July 18, 2001
This is to certify that work requested to be done as shown by Permit Number P20010530
has been completed.
Tax Map Number: 523400-302-005-0001-071-000-0000
Location: 16 GREENWAY NORTH
Owner: LOIS & TRINA PRIOR
Applicant: TRINA POCOCK
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
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Director of Building&Code Enforcement
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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010530 Application Number: A20010530
Tax Map No: 523400-302-005-0001-071-000-0000
Permission is hereby granted to: TRINA POCOCK
For property located at: 16 GREENWAY NORTH
in the Town of Queensbury, to constructor 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: LOIS & TRINA PRIOR • Septic Alteration Residential
16 GREENWAY NORTH
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY,NY
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Plans &Specifications
2001-530
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,July 17,2002
(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 T o uee pl. ; ' esi ly 17,2001
SIGNED BY - for the Town of Queensbury.
Director of Building&Code Enforcement
• , Application for Permit — Septic Disposal System
Town of Qlleensbrny 742 Bay Road Queenshu►y, NY 12804 (518) 761-8256 •
1. OWNER INFORMATION: '
1 / Office Use
Location of installation: ` ( C'c it/ �-a ly File Permit No. -ICJ
Tax Mnp No. / /
t /�
/ • Foe Paid ) �0
Owner's Name: Arc.,ic.. 76D 1t7 6"/
Address: / 6 . Cc Ay- sir rr.� '1 A' tilt
Z'
c.
2. •.INSTALLER'S NAME : ....7-, R. $ %TO(, C PHONE NO.
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1 RESIDENCE INFORMATION: (circle year of dwelling, indicate ll bedroom(,) and multiply U of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Declaims x Computation = .TQt.ill Da' -
r x 150al/bdrin = .ifli
1980 or older �J �- B f � v ✓�
1980— 1991 x 130 gal/bdrm = 1 18 20
1991 —present x 110 gal/bdrm = TOWN p� 0/
.. / no � au1 L�l N ANC Cp UR}'
Garbage Grinder Installed yes LIE
Spa or Whirlpool Installed yes / no
s
4. PARCEL INFORMATION: (circle applicable inforniation & indicate measurements) •
' • [why -' i11410_—. .0 (Quitd_.Wnl.vl_. _I3.QSl.t.r?ck.V!'_.11ttpofvi9.t.S_Mo.l2t.i.ill_ emus 'c_W Ic .Suhiily
Mitt at what depth at H het/depth tttnlc�a
t ling own feel ___ feet well
Steep slope clay if well; water supply
%slope other front any.septic-system
depth: absorption is fl.
other
' Percolation Test: (To be completed by licensed pl`r fesslonal.englneer or architect)
Pale: (it//L minute per inch
5, PROPOSED SYSTEM: For Now Construction: All individual sewage disposal systems must be designed by n licensed
professional engineer or architect (unless installed in a i'lanning iloald approved sulxlivision). Add 250 gallons to the size
of the septic tank and leach Held for each Garbage (itindcr, Spa or Whit Ipool Tub. .
Septic Tank: 11,00 gallon (min. size 1,000 gal) L /6 -( ��
.
Tito Field: each trench `Z 7 f?. 'i otal System Length: fl, —Mc/pu-, A-1
Seepage Pit(s): number of size of each: fl. b ' • ✓I• 5-0! /
Size of Stone to bo used: it / depth or rhlc/o,e.ra ,__.__,_._.,,__._fret
Bed System Size: • x
' Alternative System: length and/or size
6, HOLDING TANK SYSTEM: (if required)
Number of tanks: / Sizo of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated oloctrical work must bo 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 Ilia Town
Of Quoonsbury, any ppertmit or approval granted which is based upon or is.grattted in
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reliance upon any matotinl misrepresentation or failure to snake a material fact or
circumstance known by or on behalf of an applicant, shall be void.
I have rend the regulations with rospect to this application and agree to abide by those and all
requirements of the Town of Qucettsbury Sanitary Sewage Disposal Ordinance.
• °C.1 (77.6\-----c- gol 7-- 1„)-). 9.d /
Signature of responsible person Date
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Office Use .
GENERAL INSPECTION REPORT Inspector:
Town of Queensbury Ready at time:
Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 ARRIVE am/pnz: DEPART •--5 /pm Notes:
I
1 CL
(518) 761-8256 Inspector's Initials v�
NAME: JkfZ`��v� PERMIT# a i.....-
b
LOCATION: 'I c MA- AO ` INSPECT ON(date): i t 0
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsi.le or
providing protection from i ee.'ng
for 48 hours following the 4 lace ent
of the concrete.
Materials for this purpose on s to
Foundation/Wallpour
Reinforcement in Place
F o and ati o n/D amp p r o o fing
Backfill Approval
Plumbing Under Sl..
Plumbing Vent/Vents ni Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framing .
Jack Studs/Headers
Bracing/Bridging
iAir Joist Hangers /
Jack Posts/Main Beam
Infiltration Barrier ,,,///
Fire Separation 1,2, 3,hour_
Penetration Sealed
Fire Wall 2,3,4 hour_ —
Firestopping
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
Office Use •
GENERAL INSPECTION REPORT Inspector:
Town of Queensbury
Ready at time j 1m
Dept. of Community Development Request received: Meet:
Building& Code Enforcement , At time:
742 Bay Road ? •'
Queensbury, NY 12804 ARRIVE am/pm: DEPART ) t am/pm Notes:
(518) 761-8256 Inspector's Initials C) /�
NAME: `C `c-� `(1�_ e PERMIT# JO 0 ) 531
LOCATION: ---re,6)J 1 I ) -� 1 ,, , a
INSPECT ON(date): —i—(:)
TYPE OF STRUCTURE: , An
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is respons ble or
f
providing protection fro b free ' g
for 48 hours following th- place ent
of the concrete.
Materials for this purpose o site •
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofmg _
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in-'lace
Rough Plumbing
Heating Rough-In .
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R •
-
Walls R-
Ceiling R •
-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framing .
Jack Studs/Headers '
Bracing/Bridging
Joist Hangers
/kPosts/MainBeamfiltration Barrier Ch4L6/;r(-- & 641/X' C—,ti 5 to
/77
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour C,Q.w rR a�GI-t&CI-(
Firestopping
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAI,INSPECTION REPORT.doc
,
-..-_�___.
t REPORT Office Use
ilVE ERAL INSPECTION Inspector:
Town of Queensbury
Ready at time:
0Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbuly, NY 12804 ARRIVE a P rr Notes:
(518) 761-8256 Inspector's Init.ais
NAME: c---). _\(-6\f-C\ P--1 \VIQW PERMIT# C3-00 1-
1
LOCATION: i e e_ )---- 1, L v ,> INSPECT ON(date): o -c90061-,
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site _ •
Foundation/W allpour
. /
Reinforcement in Place •
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough P1 'bing
Heatin ough-In
• In ation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R- _
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
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L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
R-r3 ),()Iv\
TOWN OF QUEENSBURY
BUILDING_ & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name d
Loca-W , O
Date ? f 2 5(Permit 1—Ili
SOIL TYPE: San Loam-Clay-
Results of Percolation Test-
(if applicable) Ra e-Minute Inch
TYPE OF SYSTEM: c_& p r, 1
ABSORPTION FIELD: T Len.* 5;
Length of each tre chi .
Depth of trenches
Size of stone
SEEPAGE PITS: N C r-'
Size - ft. ; ft.
Stone size .�
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box a
Dist. Box to Field/P' ii I1
Openings Sealed? Yes No . :Partial
LOCATION/SEPARATIONS.
Foundation to Tank /,j�feet
Foundation to Absorptio , Z feet . .•
Separation of Pits — eet
Conforms as per Plot Pl,1n Yes No
LOCATION tF SYSTEM ON PROPER Y:
(circle one
Front - Rea, - Left Side - Right Side
Middle Fr•n.t - Middle Rear
COMMENTS:
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SYSTEM.USE APPROVED: 10NO
Arrived: ,,•
Departed: At,/
. Building Inspector
, . Ili
; - i"I have seee-or�observed,or-believe)-saw evidence of, _
t - all objects such as-houses,wells,trees,fences,
shon_on this document 1 also represent that I have
o II measured the distances set forth t the diagram.i'
BUILU1NGc personally i I -
DATE ED BY �_ 4 . — - ,�: — 7-1 Dd i
DATE j j __ SI��AT RE 1 1 DATE
I -i.,_ i_ I 1
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1, r;,.; 4�r-our- initei ex Imina�ion' i-
co"rpiiane with our corfjmenls sh II
—— not 3e cqnstried-as indi leatin the
-- -- -_ - pl��ns_and spec�fic.=�tionslare in toil — — —
cor1pliarce lth the code: —
MC. r il