2010-513 TOWN OFQ UEENSBURY
WOW742 Bay Road, NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100513 Date Issued: Thursday, November 04, 2010
This is to certify that work requested to be done as shown by Permit Number P20100513
has been completed.
Tax Map Number. 523400-296-017-0001-012-000-0000
Location: 8 CARLTON Dr
Owner. WILLIAM ROHNE
Applicant: WILLIAM ROHNE
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 thea,/a r
property owner of the responsibility for compliance with Site Plan, (17-4
Variance, or other issues and conditions as a result of approvals bythe
pp Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
!Virg 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20100513 Application Number: A20100513
Tax Map No: 523400-296-017-0001-012-000-0000
Permission is hereby granted to: WILLIAM ROHNE
For property located at 8 CARLTON 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: WILLIAM ROHNE
ELIZABETH PARRY Septic Alteration Residential
8 CARLTON Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2010-513
septic alteration residential
$25,00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,October 25,2011
(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 f Quee ury; id October 25,2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
0 Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, NE W- k •12804
TOWN OF QUFFNSBURY
Office Use Only / BUILDING & CODES
TAX MAP NO._ ? 1 t® PERMIT •
NO.__ 0 5- PERMIT FEE ' G�
APPROVALS: ZONINGTOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW FORE ISSUANCE OF A VA ID PERMIT.
OWNER:4-,ai 1 4 � 4 i`-) — - INSTALLER: .��/�r- liLLAzi, /tL cli _
ADDRESS: JP e 1 _a_t ,J Da_ ADDRESS: p 6 I 7:2-1.7:2-1.� C F
PHONE NOS. 792- ,J Zy Q
PHONE NOS. 7 / 4 - 0 �S`,
LOCATION OF INSTALLATION: 1 eA+rLL-7V r-J
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRIN�ER
1980 or older 2- X 150 = i ,0 INSTALLED?_ . ^_-
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? NJ
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING y STEEP SLOPE____ %SLOPE
I SOIL NATURE: SAND i/ LOAM CLAYOTHER
I GROUNDWATER: AT WHAT DEPTH?
I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT gEPTH?
I DOMESTIC WATER SUPLY: MUNICIPAL d//WELL (If well:water supply from any septic system absorption is: ft)
I 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).
TANK SIZE: 1 ADO 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 TYy:
ABSORPTION FIELD(WITH NO. 2 STONE) Total length i Z ft. Each trench 2-s. X- 2- I _
o SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
o ALTERNATIVE SYSTEM Bed or other type?
o 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.
I have read the regulations with respect to this application and agree to 2,ab these an. : equirem-nts of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
S ni —Sewag- pis/,•.I 11/ance. codes(tqueensburv.net
Si ture of Perso Responsible Date 0(2-445
VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
lk ( ioc ) f• 3 kiecAt-'3440.
Septic Inspection Report
Office No. (518) 761-8256 Date Ins•-«•• -1'Iv
Queensbury Building&Code Enforcement Arrive: `' '-part: 1z s i)
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: C1�^L`t01.11MIT NO.:
.70_:_c_ta
LOCATION: �i;.r' f' �` Is)r
RECHECK: INSPECT ON: .?—/r;
Soil Type. Comments and/or diagram
c ,r oam/Clay
Type of Water: uniaea Well Water
Waterli 'seglaratibil 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 _i Z L ft.
Length of each trench .: ,Z-ft.
Depth of trenches \ -
it ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank LL
Tank to Distribution Box , Y \v''
Distribution Box to Field/ Pit // "K ��
Opening Sealed: VY N �� T"
End Cap N
Inlet/Outlet Pipes&Baffles •//A,v N
Manholes 12"or less below grade VY N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank i L ft.
Foundation to absorption '7_1_ft. (,
Separation of Pits ft.
Conforms as per Plot P . . N
Engineer Report a'. • -;11__ Y N
ETU Maintenance Contract Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
stem U S t :
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
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