2006-444 TOWN OF QUEENSBURY
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742 BayRoad,Queensbury,NY 12804 902
Qu ry, 5 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20060444 Date Issued: Wednesday, January 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20060444
has been completed.
Tax Map Number 523400-295-019-0003-040-000-0000
Location: 20 FOX HOLLOW Ln
Owner. JOSEPH & LAUREL GERARDI
Applicant: JOSEPH & LAUREL GERARDI
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the , . /
property owner of the responsibility for compliance with Site Plan, 4
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060444 Application Number. A20060444
Tax Map No: 523400-295-019-0003-040-000-0000
Permission is hereby granted to: JOSEPH & LAUREL GERARDI
For property located at: 20 FOX HOLLOW Ln
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: JOSEPH & LAUREL GERARDI
20 FOX HOLLOW Ln Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2006-444
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,June 29, 2007
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town o e bury i4Th I June 29, 2006
SIGNED BY for the Town of Queensbury
Director of Building&Code Enforcement
Application for Permit- Septic Disposal System •
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
icg�U�
Location of installation: ak- ,$ Vaw 4010
L REot I V E
Z i File Permithi
S is
Tax Map No. l/9 3/ '' 'JUIV-2-6-��
Owner's Name: �.! a e __+�•/Z,lg"/�er. ! Fee P VN � URY
BUILDING,SND CODE
Address: IX A/�4, e, 1-,v e-
2. INSTALLER'S NAME : V 14'/7 1*/' r��Cii,� 0
`f' PHONE NO. � CrJ � d�c�
3. RESIDENCE INFORMATION: (circle year/ of dwelling, indicate#bedroom(s) and multipl' #of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm =
1980— 1991 LS— x 130 gallbdrm = � �D 4
1991 —present x 4 110 gal/bdrm =
Garbage Grinder Installed yes / no
Spa or Hot Tub Installed yes / no
4. PARCEL INFORMATION: (circle applicable information& indicate measurements)
Topography Soil Nature Ground Water Bedrock or Im.ervious Material Domestic Water Su..1
Flat �n„�, at what depth at what depth rnunica
'o ingi loam ! p
feet feet e
s ope clay 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 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:/2c5-p gallon (min. size 1,000 gal.)
Tile Field: each trench N4 ft. Total System Length: Jr
Seepage Pit(s): number of it.)/4— size of each: It. by ft.
Size of Stone to be used: # 2- / depth or thickness 6 y
Bed System Size: !) ! J45. r
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 Tow sbury Sanitary e Disposal Ordinance.
GIS
Si ael/ea
of re o sible person 1 Doty
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
ti SEPARATION REQUIREMENTS
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Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
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Septic Inspection Report
Office No. (518) 761-8256 Date Ins ion requ�i - eiv-•.
Queensbury Building &Code Enforcement Arrive: °'cry a L� i :••it: \f am
742 Bay Rd., Queensbury, NY 12804 Inspect° s Initials: lip,
NAME: I j PE' NO.: Os- a
LOCATION: oL-)"- ISP- ON: -•
RECHECK:
Comments and/or diagram
Soil Type: San• .-m/
Type of W• . unici•. ell Water
Waterline sepa = _ •nce ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length i4, - i) \ s_ ft•
Length of each trench ` `i7[7 t Y�'Y, ft.
Depth of trenches ` 11, -.3 ft.
Size of Stone
Seepage Pits: Number
Size: x--- -•-^
Stone Size:
Piping Size Ty
Building to tank /5
Tank to Distributio Box 1 ' ,�O
Distribution Box • -e ' / Pit 1-.\\l 1)4'-2 YQ--
Opening Sealed N/ Partial
End Cap 13
Inlet/Outlet Pipes&Baffles Y—N
Location/ Separations
Foundation to tank e 5?lrft•
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _ __Y N
Engineer Report and As-Built Y Y—N
Location of System on Property:
• :.r Left Side Right Side
Middle Middle Rear
S -m • - mus:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
RECEIVED
JUN 26 2006
TOWN_f____I OF L uc_NSBURY
BUILDING AND CODE
i :i . or ,,;,,erve.i, or believe I saw eviden''e ot,
iII�IIP JP.GrI ,. � ��
: ��' ects such as houses, wells, trees, fences,
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s i,o„t��t,�,..t. i a'�o represent tl;at l have
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TOWN OF ea NSBURY BUILQIN ��ARTMENNT
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Based on our limited examine",n,
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compliance with our comments shall
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not be strued as indicating I Z0 --_ .
plans and specifications are In
complian with the Building Codes of 1
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