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2011-206 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)161-8201 Community Development-Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110206 Date Issued: Friday, May 20, 2011 This is to certify that work requested to be done as'shown by Permit Number P20110206 has been completed. Tax Map Number: 523400-301-013-6002-001-000-0000 Location: 28 BRONK Dr Owner: RONALD & GLORIA WEIDERHOLD Applicant: RONALD & GLORIA WEIDERHOLD 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, 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: P20110206 Application Number: A20110206 Tax Map No: 523400-301-013-0002-001-000-0000 Permission is hereby granted to: RONALD.&GLORIA WEIDERHOLD For property located at. 28 BRONK Dr 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: RONALD &GLORIA WEIDERHOLI Septic Alteration Residential 28 BRONK Dr Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011-206 septic alteration residential $40.00 . PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,May 17,2012 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the To of Qu ensb W T st114ay 17 2011 � SIGNED BY for the Town of Queensbury. Director of Building&_Code Enforcement pECE E Revised 4/1 OF=F C®i�S ONLY I T (AS�(�iAAPINO. �-l PERMIT NO.-��I���-,�PERMIT F EU TOWN O QUEENSBURY BUILDING&CODES APPROVALS: ZONING TOWN CLERK _ APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. l- f_ OWNER:���tG Jl/ l/`�I/n �[mot 0�1� INSTALLER: ADDRESS:�� 'gyp( tl f/�/d'^ ADDRESS:T F !j CvPl t�„� r C PHONE NOS. 9 X ��y ` PHONE NOS' �E( Q LOCATION OF INSTALLATION: r!" f����/� CO r RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS Gallons per bedroom - GARBAGE GRIN 1980 of older X 150 = Ji INSTALLED? 1981-1991 X 130 = SPA OR HOT TU 1992-present X 1 110 = AIA INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEPASgL�OP %$LOP ✓ SOIL NATURE: SAND, LOAM/V/A CLAYLA_ OTHER ✓ GROUNDWATER: AT WHAT DEPTH? A.IA ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA EPTH? PA ✓ DOMESTIC WATER SUP LY: MUNICIPAL WELL (If well:water supply from any septic system absorption is:_ ft) ✓ PERCOLATION TEST: RATE IS A Z-A PER MIINUTE PER INCH[mpli (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed'professional engineer or architect(un'lames/s installed in a Planning Board approved subdivision). TANK SIZE:L p G��G�� GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,spa or whirlpool tub. SYSTEM TYPE:❑ABSORPTION FIELD(WITH NO.2 STONE) Total lengthl _�_f. Each trench_ _X_O ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many?. �1.� Size? T1 ❑ALTERNATIVE SYSTEM Bed or other type? MA ❑HOLDING TANK SYSTEM Total required capacity? AAA Tank size? AM Number of tanks NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 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 QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Sewa isposat Ordina codes0oueensburv.net C VISIT OUR WESSITE FOR MORE INFORMATION Sign ure of Person Responsible Date www.pueensbury.net Town of Queensbury"Community Development Office"742 Bay Road, Queensbury NY 12804 IR /0 12- r_ Septic Inspection Report Office No. (518) 761-8256 Date Ins on r i Queensbury Building&Code Enforcement Arrive: - (� a a;�� 742 Bay Rd., Queensbury, NY 12804 Inspector's Inca NAME: �' ERMIT NO.: LOCATION: n INSPECT ON. �l RECHECK: Comments and/or diagram Soil T am Clay Ty of Water Munici I Water Water i ration distance ft. F o,� A�D Well separation distance ft. Other wells: ft. Well Casing Length 50' +/- Y N N/A 150'to well required if NO Absorption Field: Total length ft. Length of each trench -ft. Depth of trenches ,ft. Size of Stone Seepage Pits: Number Size: x Stone Size: i Piping Size Type Building to tank y " ' LADESt-��t Tank to Distribution Distribution Box to Field/ Pit Opening Sealed: Y N End Ca _N Inle Outlet Pipes&Baffles Y. M Wholes 12"or less below grade N rovlde extension collar if Yes Y N Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N ETU Maintenance Contract Y N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use S tus: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Forms\Septic Inspection Reporl`03 2910.doc l - Septic Inspection Re ort Office No. (518)761-8256 Date Inspection r Ived: Queensbury Building&Code Enforcement Arrive: `".% a rt: 7_'•LP am r,�� 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials NAME: � PE IT NO.: LOCATION: Z�', t�,Rp IN ECT ON: S]—1�—11 RECHECK: V-_f^taC AV-%icl� Comments and/or diagram Soil T m/Clay Type of Water: u al ell Water Waterll aration distance z::> ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A 150'to well required if NO Absorption Field: Total length ft. Length of each trench ft. Depth of trenches t-k ft. Size of Stoneo►JE-TC Seepage Pits: Number \<`I pS Size: x F►es�bFl 6 Stone Size: 7 Piping Size Type Building to tank i Tank to Distribution Box t-�'� C Distribution Box to Field Pit `i CG -M Opening Sealed: N End Ca N Inlet/Outlet Pipes&'Baffles Y - Manholes 12"or less below grade N [provide extension collar if Yes Y N Location Separations Foundation to tank r ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot P N Engineer Re rt and -�rc uil Y N ETU Maintenanc Cont Y_N rovided Location of System on Property: Front tODftrOV ide i ht Sid Middle F nt Middle Rear S em U ed and needs to be re-ins , please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Rorms\Septic Inspection ReporL03 2910.doc " 01 I -M A O�I(Q1U� 2�,1-1- - -TfI-• T-I---�I--!-!T___li--._�I-- -II�--NS3 �-E G I I —QBWCdDE DI�G .I rI - - I - I I � I I i I I I i i I � -j'0_j I , I 1- ---I-- - •- ..I—I - - I--- - -- ----- -I- --r--. _ ..- --_ _� ;.___-__ -I .... `T ago,Sean- all ���'��erved �r b liev -1 sauv-��a III�i r�c� o - }� I t lOb,4crS 'Iljch �rj� ou3e$ V+eP, t,- S fp.riv,a h,�'�---'o hi i �'iI I•';j i alA re,� ', , �_;"S�a fi�l _ i .. 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