2011-420 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: P20110420 Date Issued: Tuesday, August 23, 2011
This is to certify that work requested to be done as shown by Permit Number P20110420
has been completed.
Tax Map Number: 523400-316-010-0001-028-000-0000
Location: 12 ARBERGER Dr
Owner: CHERYL WINSLOW
Applicant: CHERYL WINSLOW
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&CXde Enlorcernent
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: P20110420 Application Number: A20110420
Tax Map No: 523400-316-010-0001-028-000-0000
Permission is hereby granted to: CHERYL WINSLOW
For property located at 12 ARBERGER 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: CHERYL WINSLOW Septic Alteration Residential
RICHARD WINSLOW Total Value
13 RUSH HOLLOW Ct
QUEENSBURY NY 12804-0000
Contractor or Builders Name/Address Electrical Inspection Agency
BRADLEYS SEPTIC
654-6318
47 HACK Rd
CORINTH.NY 12822-0000
Plans&Specifications
2011-420
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 22,2012
(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 Town 61 bury• M0 'August 22,2011
SIGNED BY ( �� for the Town of Queensbury.
Director of Building&Co e Enforcement
OFFICE USE 0 LY 'u' .�
/�/ �� is
X AP NO. PERMIT NO. 12 ' ERMIT FEE I;
L��1
APPROVALS: ZONING TOWN CLERK OWN OF IUEE
$t OF QUQr;J.a8L1Ry
V CODES
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT = REVIE EFORE ISSUANCE OF A VALID
PERMIT. �/
OWNER: K','c`C ¢-G�,e�! 6-4/�S/Qi✓ INSTALLER: Akeir�' � ``/ ,
ADDRESS:/<2 A/'6or .,er /. ADDRESS: `-/ ( /ff /eV (12,64 ''
1 � 0
PHONE NOS., 1`S-6-77 PHONE NOS. `�
LOCATION OF INSTALLATION: /.2 /r 4e er � Qu
RESIDENCE INFORMATION:
YEAR BUILT I NO.OF BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
- GARBAGE GRINDER
L 1980 or older 3 t 150 gallon per bedroom = ilk() INSTALLED? No
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom I = INSTALLED? /t?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling X Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal X Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is minutes 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).
TANK SIZE: 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: t //4
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length tele ft. Each trench 3 x /80
❑ 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?
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.
(2 :o ) /-- frojL-
Septic
Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
pecbo
742 Bay Rd., Queensbury, NY 12804 Ins C
rfs I IS:
NAME: UV+ PERMIT NO.: ii-4/70
LOCATION: 17 a Y'- INSPECT ON: -22 II
RECHECK:
Comments and/or diagram
Soil Type• •; lay
Type of Water: unicipa Well Water
Water) ' - -.,ration 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 /&7 ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone (,-) 0L–c" c c1 6"14
Seepage Pits: Number
Size: x
Stone Size:
Piping Size , Type
Building to tank nis- _
Tank to Distribution Box 'r
Distribution Box to Field/ Pit
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes&Baffles Y._,_t✓�
Manholes 12"or less below grade _Y._.
[provide extension collar if Yes] Y—N
Location/Separations
Foundation to tank ft.
Foundation to absorption '7) ft.
Separation of Pits ft.
Conforms as per Plot Plan LY- -_N
Engineer Report and As-Built Y—N
ETU Maintenance Contract Y N
provided
Location of System on Prope .
Front . -.r +; Left Si Right Side Middle Front Middle Rear
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspecdon Forms\SepOc Inspection Report_03 29 10.doc
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TOWN OF QUEENSBURY
BUILDING DEPARTMENT ��
Based on our i • ;, ' . :_ vs
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with our comments shall not be construed as
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_the plans and specifications are in ,- ti
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