2010-187 TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100187 Date Issued: Friday, May 07, 2010
This is to certify that work requested to be done as shown by Permit Number P20100187
has been completed.
Tax Map Number. 523400-301-005-0001-013-000-0000
Location: 16 SAWN Rd
Owner. HENRY & SYLVIA BEATON
Applicant HENRY & SYLVIA BEATON
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&Code Enforcement
Planning Board or Zoning Board of Appeals.
1
TOWN OF QUEENSBURY
clf4ro 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100187 Application Number. A20100187
Tax Map No: 523400-301-005-0001-013-000-0000
Permission is hereby granted to: HENRY& SYLVIA BEATON
For property located at: 16 SAWN 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: HENRY & SYLVIA BEATON
16 SAWN Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2010-187
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,April 27, 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 Town of Queensbury; Tuesday,April 27,2010
SIGNED BY '1 for the Town of Queensbury.
ctor of B 'din. .s\ nforcement
For an EPA homeowner's guide: htto://www.eoa.gov/nodes/pubs/homeowner guide.dor q s#omize.gdf .
4 j i; e!: :_,lis_J
OFFICE USE ONLY -"°2.5 I
TAX MAP NO`S -,, -1 �pERMIT NO.j ) jg"�PERMIT FEE � t
JJ P.. . 2010
APPROVALS: ZONING TOWN CLERK
ate..
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC 0 REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. l ,�r�
OWNER:it (2'1°11 Li 'e� 7-D,,7'`1 INSTALLER: r lu ( L /a-G-14-C,O C' U'!C.r
ADDRESS:.� ja_L.Liik)SoFi J ADDRESS: p`) U'L 7-2-" / -, c
•
PHONE NOS._7 22 6_31...5-- PHONE NOS. 796 — O P ,St, f
LOCATION OF INSTALLATION: I sTkAr J "`
RESIDENCE
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
BEDROOMS
1980 or older =
[J� X 150 gallon per bedroom �1a ° GARBAGE GRINQER.
1981 -1991 INSTALLED? ci
X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA OR HOT TUBO
INSTALLED?
PARCEL INFORMATION:
/ TOPOGRAPHY: FLAT ROLL ✓/ STEEP SLOPE SLOPE
✓ SOIL NATURE: SAND LOAM CLAY_____ OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC R SUPLY:
MUNICIPAL WELL _(If well:water supply from any septic system absorption is:( ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE 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 engineer or architect(unles,s installed in a Planning Board approved subdivision).
0 0 F,-t,f;6�Jlo
TANK SIZE: J 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:
o ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
EEPAGE PIT(S) (WITH NO. 3 STONE) How many?_ D-__ Size? � °�>4 1
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 QUESTIONS? CALL 761-8256 OR EMAIL
to abide by these and all requirements of the Town of Queensbury codesCa�queensbury.net
Sanitary Sewage i •osal Ordinance.
VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Si ure of Per- .n Res onsible ��
ca,9 p Date
Town of Queensbury Community Development Office • 742 Bay Road, Queensbury, NY 12804
( Zoc) z 4 7AL 'r(So4
Septic Inspection Report
Office No. (518) 761-8256 Date Ins iFdquest received:
Queensbury Building &Code Enforcement Arrive: am/pm
742 Bay Rd., Queensbury, NY 12804 Ins s Initials:
NAME: _ PERMIT NO.:
LOCATION: '�- INSPECT ON: ! - '1911` �►
RECHECK: -
Comments and/or diagram
Soil Ty, Loam/Clay
Type of Water: Municipal Well Water
Waterlin- --;; .tion 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 ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Piping §ize Type
Building to tank -f�ry
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: N
End Cap
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade _N
[provide extension collar if S Y N
Location/Separations
Foundation to tank ft.
Foundation to 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 Sys - • •n • operty:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Stat.u(
V 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 Inspection Report 03 29 10.doc
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,i.1,•,P. Pn this document. I &so represent that I have
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