2011-321 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development ' Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110321 Date Issued: Friday, July 01, 2011
This is to certify that work requested to be done as shown by Permit Number P20110321
has been completed.
Tax Map Number: 523400-290-000-0001-050-000-0000
Location: 192 SUNNYSIDE EAST
Owner: PAUL &DIANE ALAGNA
Applicant: PAUL & DIANE ALAGNA
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Q
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 b the
pp y 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: P20110321 Application Number: A20110321
Tax Map No: 523400-290-000-0001-050-000-0000
Permission is hereby granted to: PAUL&DIANE ALAGNA
For property located at: 192 SUNNySIDE EAST
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: PAUL&DIANE ALAGNA Septic Alteration Residential
192 SiTNNYSIDE EAST Total Value
QUEENSBURY,NY 12804
Contractor or Builder's.Name/Address Electrical Inspection Agency
Plans&Specifications
2011-321
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,June 30,.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 T n.o ueen rya dh> ,June 30,2011
SIGNED BY. '' ` `J. for the Town of Queensbury.
Director of Building&Code Enforcement
4 1
OFFICE USE ONLY �0
TAX MAP NO.� PERMIT NO. t� ��/ PERMIT FEE /D JUN 2 8
2011
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM pERIFITTOWN OF UULLNjIJURY
BUILDING & CODES
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION ro—REVIEW BEFORE
ISSUANCE OF A VALID PERMIT.OWNER: PCA(4/•�� AIGI(JlincA INSTALLER: -10 C J a, /�`
ADDRESS: 1 Lr G1r� I _ .OI S`I ADDRESS: 'O < (A V(11�
PHONE NOS. `f r2�)L PHONE NOS. 9 6
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X Gallons per bedroom = TOTAL DAILY FLOW GARBAGE GRINDER
1980 or older X 150 = 450 INSTALLED?
1981-1991 X 130 = SPA OR HOT
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND J LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? Iy
✓ BEDROCKIIMPERVIOUS MATERIAL: AT WHAT DEPTH? _
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL(if well:water supply from any septic system absorption is: 1Q® ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi)
(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(unless installed in a Planning Board approved subdivision).
i
TANK SIZE: MO 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: y
❑ABSORPTION FIELD(WITH N0.2 STONE) Total length 2.4�f' _ft. Each trench 4 X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? _''\\ Size? �V A
❑ALTERNATIVE SYSTEM Bed or other type? N N
❑HOLDING TANK SYSTEM Total required capacity? Tank size? W 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 Sewage isposal Ordina e. I codesCa)aueensbury.net
6' l VISIT OUR WEBSITE FOR MORE INFORMATION
Signatur f Peirs"646VpAVible Date www.ciueensbury.net
Town of Queensbury*Community Development Office*742.Bay Road, Queensbury NY 12804
1 -3
Septic Inspection Report
Office No. (518) 761-8256 Date Ins on ived:
Queensbury Building&Code Enforcement Arrive: rt: a
742 Bay Rd., Queens ;6NYj 12804 Inspector's In
/l_ �21NAME: 1��� E' IT NO.:
LOCATION: �,In� S ` ? INSPECT ON:
RECHECK: -
Comments and/or diagram
Soil T an o,W Clay
Type of Water: VlQkn I ell Water
Waterline separation distance ft.
Well separation distance
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
Size of Stone ?�
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box 41%
Distribution Box to Field/ Pit }r
Opening Sealed: _ N
End Ca N
Inlet/Outlet Pipes&'Baffles Y r-
Manholes 12"or less below grade _N
rovide extension collar if Yes Y N
Location I Separations
Fmwititiowto tank ft.
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 ear Left Side ight Side Middle Front Middle Rear
System Use S us:
Approved
Partial Approved and needs to be re-Inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspectlon Reporr`03 2910.doc
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