2011-494 elak TOWN OF QUEENSBURY
torig742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110494 Date Issued: Thursday, October 20, 2011
This is to certify that work requested to be done as shown by Permit Number P20110494
has been completed.
Tax Map Number: 523400-308-006-0001-071-000-0000
Location: 48 BURCH Rd
Owner: JAMES & JO ANN CONNELLY
Applicant: JAMES & JO ANN CONNELLY
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 ~ fry` A•property owner of the responsibility for compliance with Site Plan, _ J ;
Variance, or other issues and conditions as a result of approvals by the
Planning Board or Zoning Board of Appeals. Director of Building& ode orcement
TOWN OF QUEENSBURY
g4t$1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110494 Application Number: A20110494
Tax Map No: 523400-308-006-0001-071-000-0000
Permission is hereby granted to: JAMES &JO ANN CONNELLY
For property located at: 48 BURCH 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: JAMES &JO ANN CONNELLY
48 BURCH Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
FRED SMITH
798-1836
OUEENSBURY,NY 12804-0000
Plans&Specifications
2011-494
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,October 04,2012
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Townnf Qneensbu,>ry; Tlfeid$ Ogtober 04,2011
/
SIGNED BY ` :r �` ` i °" for the Town of Queensbury.
Director of Building&Code Enforcement
-/ — ?/
• OFFICE USE ONLY !r ,If, F "�
MAP NO. PERMIT NO. �` /�L '
�I/ 1ERMIT FEE (I 4 ;r 3
APPROVALS: ZONING TOWN CLERK i I L, , C::: , ,! ? I i!
' f'
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.
OWNER: ,1/4.../b jj4/ n (Of)fl(/ �1
INSTALLER: / (i
Sm/71
ADDRESS: �8
0 fd ADDRESS: /9 irMi / Al-e
PHONE NOS. 77 6q99 99 PHONE NOS. 7F 6i8 3 '/..3 / 09',..c6
LOCATION OF INSTALLATION: I41'((A ied
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDMS X COMPUTATION= = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom Z/50 GARAAGE GRINDER
INSTALLED?
1981 -1991 X 130 gallon per bedroom =
SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
/ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand `., Loam Clay Other
/ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At vyhat depth?
/ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is per minute per inch.
(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 en ineer or architect (unless installed in a Planning Board approved subdivision).
TANK SIZE: ,a ci '��LONMIN. 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 length did ft. Each trench 0., x SO
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
ii NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
ii APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
Iii
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.
( 11100 ) 1O--/Z_ Fri .
Septic Inspection Report
i
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm De rt: /45_9,..1m/pm742 Bay Rd., QueenAu , NY 12804 Inspector's Initials: ' '/`
NAME: Cd'! _� C PERMIT NO.: / ( —/7J)rte4
LOCATION: / ur .Jf f INSPECT ON: 0-- 7-1/
RECHECK: /
Comments and/or diagram
Soil Type• Loam/Clay
Type of Water: nigpll/Well Water
Waterline separation distance 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 Cl 0 ft.
Length of each trench ft.
Depth of trenches I `' -ice
Size of Stone a Z
Seepage Pits: Number
Size:
Stone Size: tqlciji --
Piping Size Type •k1�. --
Building to tank , , --� `�
Tank to Distribution Box IL.3
Distribution Box to Field/ Pit ;S%?r?— -5A---P61-1..c
Opening Sealed: Y/_N
End Cap •./V _____N
Inlet/Outlet Pipes&Baffles �/Y Z C:yri-c.v;,� 'L i' -rzr-- .. --�-�
Manholes 12"or less below grade Y N
[provide extension collar if Yes] Y N!}-
Location/ Separations
Foundation to tank t ft.
Foundation to absorption ft.
Separation of Pits .. /ri - .
Conforms as per Plot Plan . _N
Engineer Report and As-Built Y N
ETU Maintenance Contract Y_ N
provided
Location of System on Property:
Front " -.r Left Side Right Side Middle Front Middle Rear
em - . .
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 Repa#_03 29 10.doc
„
I 1• -
i
t
t /IF ...
,,,,
1 - ) \ ‘..)sj
ly .'
)0
,--.,
--)
fr.'0P4
__J
__ _ D
• V ",4”
. —...........,....... ._.. „.. „.._—
„ ..„ . ..„...
'• ," i t,i'1: .,_,
1 i .
1 i
I ,
? . . .
' "' . sl',.
'It,,k I.‘.:'' ........,...*
II i
ii,-:.4 ....)1 1 I A6
te. ,•
----,- Ifi'.
P
i
TOWN OF QUEE SBURY . ,
,
BUILDING DEPARTMENT
', i ,
Based on our limited examination,compliance '
.'s,,/
. --,/
,
with our comments shall not be construed as
,
- i--). . _ - - ----- 1
mdicating file plans and cifications are in— ,.
i
full compliance with the uilding Codes of
New York.State.
I
. ' .,.
1 1 .
. . . •
, ,.
1 .
i I
/I 1
1 I - . . .
, , , () , i ,TOWN OF Q0EENSBURY / ..,
}
,---- •k,
BUILDING & bODES DEPT.
ReviewedEH i ti
IX1 " •
Date:
• t,.erved, ot. HI,eve I saw
t
l 56 \ V'
0Jelh= ' -----.
t
,
...1.... .
i
.... ..
„ ..__ ...
.. .....- .,
,,
, ,,,, ,,,.„.„
-1- 4...AAA..r., r i v r L.,1 . 7 L.-
V°
......0
: •,
i •, i
T\ .
../. Citil I LW:C.' ...-..--•:....Y:".."`' '';• ,''' i
3 'Cl,....
...--- .
--,
'. ',eve I saw ,,..••
serverf or V...,t tt"---""'-'-'''---"---'-----:--) —
.
7eS we!i'
+,.... ....;
, ,'•N .
.• ' ' -,))...T.7..,
4...
.,
411111111111,........... 11..........wmonomme, W....1\Loww•maw.
'..
N. (S
1
I*
...
z_... %,....
1 ,9.;;;"`'.•
I V
.•..or
”......, •
_.
...........
N 0
3
— -- )0/1nrt Coe)11 nee i 1 tol
...:
_. 1
p...
. 77 -'1.•
N 1 • ..,
... .
- .. .. . . . .„..„„...._