2010-437 TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
F'wo
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100437 Date Issued: Wednesday, September 08, 2010
This is to certify that work requested to be done as shown by Permit Number P20100437
has been completed.
Tax Map Number: 523400-308-019-0001-016-000-0000
Location: 52 DIVISION Rd
Owner: PAUL & ADELE BALLOU
Applicant: PAUL & ADELE BALLOU
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 (DJ 4
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100437 Application Number. A20100437
Tax Map No: 523400-308-019-0001-016-000-0000
Permission is hereby granted to: PAUL&ADELE BALLOU
For property located at: 52 DIVISION 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: PAUL&ADELE BALLOU
52 DIVISION Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans &Specifications
2010-437
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, September 01, 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 th Town Qu b , r •sday, September 01,2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. it' M4IT FEFEE
APPROVALS: ZONING TOWN CLERK
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. PCk
OWNER: ((-D lJ INSTALLER: J. , 1> 5 SCA) / C.
ADDRESS S` ,,[ (J/ VI S O 1. ) ADDRESS: #02 0 (L (t IL G ((A J/
PHONE NOS. PHONE NOS. 77 '_ j--/.
fr
LOCATION OF INSTALLATION:
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BED ODMS X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER,
1980 or older X 150 gallon per bedroom = 3 a � INSTALLED? ////JSS
1981 -1991 A/ X 130 gallon per bedroom = frAN SPA OR HOTT
/
1992-present ,/ /�-- X 110 gallon per bedroom = /f,4 INSTALLED?/_
PARCEL INFORMATION:v / '�
✓ TOPOGRAPHY: Flat rolling Steep slop6l."? ! %Slope A
✓ SOIL NATURE: Sand Loam A,4Q Clay /in Other //A
✓ GROUNDWATER: At what depth? /01--
• BEDROCK/IMPERVIOUS
ABEDROCK/IMPERVIOUS MATERIAL: At what depth? 4,4
✓ DOMESTIC WATER SUPLY: Municipal X Well /Oh- (If well: Water supply from septic
system absorption is � '71 ft.)
✓ PERCOLATION TEST: Rate is ' 1 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: /97 v 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: � //
ED ABSORPTION FIELD (WITH NO. 2 STONE) Total length/(// ft.
Each trench �f4 X /V/i
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? 4/A4. Size? r2,/4
❑ ALTERNATIVE SYSTEM Bed or other type? ,V7 J
❑ HOLDING TANK SYSTEM Total required capacity? /VA
Tank size? //..//12e" 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 :oo) /o1Z_ .
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: //s 5m/pm
742 Bay Rd., Queensbury, NY 12804 Inspecr's Initials:647
NAME: PERMIT NO.: /t2 /37L
/
LOCATION: /
INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type:O / Loam/Clay
Type of Water: .'1t�"t;I/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
Length of each trench
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Aze �
Building to tank v`
Tank to Distribution Box kp—
Distribution Box to Field/ Pit CT' `C C44-421—A' 5 ( �-
Opening Sealed: Y N
End Cap ___K N
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade Y_N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank / 0 ft.
Foundation to absorption ft. "12— 1t,? -sC-.s ?UN—
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 System on Property:
ront Rear Left Side Right Side Middle Front Middle Rear
System Use S us:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forns\Inspection Forms\Septic Inspection Repoi#_03 29 10.doc
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