2011-395 TOWN OFQ UEENSBURY
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742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Q ury,
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110395 Date Issued: Tuesday, August 09, 2011
This is to certify that work requested to be done as shown by Permit Number P20110395
has been completed.
Tax Map Number: 523400-308-006-0001-004-000-0000
Location: 39 BURCH Rd
Owner: JAMES VAN DORAN
Applicant: JAMES VAN DORAN
This structure may be occupied as a:
Test Pit/Perc Test Review
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (
^ r /9 g/ f t, ...
property owner of the responsibility for compliance with Site Plan, '` `�t}�' f `
P
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
Fivo 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110395 Application Number: A20110395
Tax Map No: 523400-308-006-0001-004-000-0000
Permission is hereby granted to: JAMES VAN DORAN
For property located at: 39 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 VAN DORAN
BRENDA GRANGER Test Pit/Perc Test Review
39 BURCH Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-395
deep hole/perc test
$200.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 09, 2012
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tow of Q nsb ; / Tits/ ' , gust 09,2011
j'
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
trY
Town of Queensbury■ Building&Codes Enforcement Office•742 Bay Road■ Queens i :r
DECEV
DEEP HOLE/PERC TEST
Request for Town Engineer Re i . AUG
Property Owner: .. =fir t l' - 'I.`'`; -f I i Phone: TOWN OF QUEE
NS
BURY
OS
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Property Owner's ' :i
_ . , t•-\ ,, "_, (1,-,‘ c t w,�i
Address: �,,� i, � �� � �,�` ��_. ; ."� t .t
Location of Test: - -- . - - _ -i- -- Tax ID#: ` --' i ` '
*Applicant's Engineer: `_ , , , a �< . . Ph z
'- `:� ;�; t `� �$� ons: _� � L. "I ,�;; Li-
Applicant's Agent: , , i Phone:
Additional Notes:
1. Reason for Request? New Septic System 17 Replacement Septic System Failed Septic System
i
Subdivision Site Plan Review
2.Are Wetlands present? YES [-1 NO UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the system. The Town
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with applicatio AeiLett
FE - ■
a. $200 Flat Fee Date Paid: 871/e
_ Check No.: /03.4,-`
. t; Fe- : •*- determi•.• •uring To Be Determined: 4, 1
` , - an/ ••'. Sion revs- • ••r-SS
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed$1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per-Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICANT: Date:
SIGNATURE OF AGENT: f-
Date:
.�:
i i
Original (B&C File) Canary(Planning) Pink(Applicant) Gold(Town Clerk)
•
Town of Queensbury• Building&Codes Enforcement Office■742 Bay Road■ Queensbury,NY 12804
DEEP HOLE/PERC TEST
Request for Town Engineer Review
Property Owner: Yai-l)o(en Phone:
Property Owner's r/ �!,�- `1
Address: D-1 '(. Rcm e(A, A.C,c S 1 J i v
Location of Test: 3C Q 0 R j)l c P i ntAfs ( Tax ID#: 3 a, (p -- 1- Li
*Applicant's Engineer:V NON) ifeex%,,.. fDIktsi t y)1/4-I.( Phone: 1/3 1c 2_ q2-(04-• k:. 1 I I-
Applicant's Agent:.-Taill Kliall Phone:
Additional Notes:
1. Reason for Request? New Septic System Replacement Septic System Failed Septic System
Subdivision Site Plan Review
2.Are Wetlands present? YES X NO UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the system. The Town
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
F - r --EDULE:
a. $200 Flat Fee Date Paid: S7-F-//
��.. .�__--- - '
- Check No.: / 5'4., �_.
b. O* F t be dete :n'rle du ng / ''d To Be Determined: ,f .
�.i Ian Subd' islo `evie mess ,�:
,
SIG ATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICANT: Date:
SIGNATURE OF AGENT: % or _ Dater '0 -@.011
Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
CONTRACTOR TO REMOVE EXISTING SEWER n EXISTING HOUSE SEWER TO BE
TRUNK LINE ALONG SOUTH FDN WALL IN " CUT AND CAPPED AT INTERIOR
BASEMENT AND REPLACE WITH 4"0 SCHED 40 •
FON WALL AND EDGE OF
PVC TRUNK SLOPED TO NEW OUTLET LPORCH,REMOVE REMAINING
LOCATION RECONFIGURE AND RECONNECT SEWER TO TANK '
ALL EXISTING SEWER DROPS AND VENTS AT - •
INTERIOR AS REQUIRED - ,�-
300'1 PROPERTY LINE _ — 1 , APPROXIMATE LOCATION OF
�� EXISTING SEEPAGE PIT
" ..- i o 1 (TO BE PUMPED.REMOVE AND
---------------- I DISPOSE OF TOP AND FILL WITH
XISTICLEAN SAND FILL)
-------
-------- .-- _ . /ENG
(TYP) o
TOTAL AREA= CLEANOUT TO 0 1
r _ _ _ _-- - GRADE
0.69±ACRES Nv.THRu FDS' C
1 1250 GAL SEPTIC TANK, 96.6'z r .,'.0 I
CONTRACTOR TO LOCATE • --''-¢%%'-%.Lt; o
)� 1 IN EXISTING CLEARING, \ 4"0 SDR-35 AT
MINIMUM 50 FT TO WELL MINIMUM 2% r- _ , E.%�: . -_l i', • _ -r1
INVERT IN 950''- 1 *KC ' O 1 N
SLOPE.HOUSE d j�,: �RAcf;_.
INVERT OUT 94,83'3 TO TANK / v VN-i' ` _ 1 0
I APPROXIMATE \
LOCATION OF 4"0 SDR-35 AT F -
1 / l 1,I',:f I ,
EXISTING MINIMUM 1%SLOPE,\ I I Ti---- �— I. Q
TREELINE TANK TO D-BOX \ _ DRNEW
1AY _
7 ,
--- ,,,_,.____E-__,,,„:
„_., ,
_ •,,, ,
'z- O ATH#1 APT#3 ..r,.- .. DI
.�t,APT#2 _ .._' -` -
,r,, II,:
Tr
1 .. I ..
ZO ` 1 D-BOX - - - -
I INVERT IN 94.4'3 - -- 0 —
.\;
PROPERTY LINE SETBACK_I —�
0'MIN /
�� —FPRO%IMATE-- r APPROXIMATE LOCATION OF
---- LOU' ION OF EXISTING 10003 GAL SEPTIC TANK
_ _ ��� _ OBSERVED OVERLOAD (TO BE PUMPED,REMOVE AND
1 — — - U-ILIT1'EINES a DISPOSE OF TOP,AND FILLED WITH
— ,��� CLEAN SAND FILL)
— - APPROXIMATE LOCATION OF
__ =.LA 10^.CIST%•N)..E EXISTING SEEPAGE PIT
SEPTIC ABSORPTION FIELD '•-•- r'R SE IC TAN. . (TO BE PUMPED,REMOVE AND
WITH MINIMUM(4)41 FT DISPOSE OF TOP,AND FILL WITH
ABSORPTION TRENCHES, CLEAN SAND FILL)
CONTRACTOR TO LOCATE IN --,;.II,t,C'WELL
EXISTING CLEARING:MINIMUM :",='''.-•,=I ION CIS IAPT-T)
100 FT TO WELL FROM ANY , -F I'P AEVJk'"101
ABSORPTION FIELD -;:',LII A,),--S ,T
COMPONENT OR D-BOX,AND .
MINIMUM 10 FT FROM GRAPHIC SC
PROPERTY LINE
20 0 10 20
(IN FEET)
1 INCH=20 FT
OSEPTIC PLOT PLAN
1 INCH=20 FEET
NOTE:REFERENCE
ELEVATIONS SHOWN ARE IN
REFERENCE TO ELEVATION
100.0'=TOP OF EXISTING
BLOCK FOUNDATION WALL