2010-086 .4.411h TOWN OFQ UEENSBURY
742 Bay Road, NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100086 Date Issued: Monday, March 22, 2010
This is to certify that work requested to be done as shown by Permit Number P20100086
has been completed.
Tax Map Number. 523400-308-008-0001-067-000-0000
Location: 22 KYLIANS Way
Owner. DAVID & JOANNE CALLAN
Applicant: DAVID & JOANNE CALLAN
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 Tii)a4if2(17). J
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
coN 742 Bay Road Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100086 Application Number. A20100086
Tax Map No: 523400-308-008-0001-067-000-0000
Permission is hereby granted to: DAVID &JOANNE CALLAN
For property located at: 22 KYLIANS Way
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: DAVID &JOANNE CALLAN
22 KYLIANS Way Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-086
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,March 17,2011
(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 own o ee u , !� •: a ay, March 17, 2010
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
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TAX MP NO. PERMIT NO.2O/O`O ERMIT FEE ts---
i , k,,s. - _: 1 .810
•APPROVALS: ZONING TOWN CLERK q` ry
TOWNr; c,� ys31,`:iyi.
eUILDIN°a & CODES
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.
OWNER: ,U A A/4 CC.- (//
�(),- ti INSTALLER: --r. l} e I Sit. .
ADDRESS: /r/ /At 'li ADDRESS: 7t)_ /0 Li—El" ( t--0 /V-(ti cs/
PHONE NOS. PHONE NOS. 7 Yr- k(Pp
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LOCATION OF INSTALLATION: p` fi Vt u--��
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RESIDENCE INFORMATION:
NO.
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER'
1980 or older X 150 gallon per bedroom = INSTALLED? G
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB '`
1992-present 3 X 110 gallon per bedroom = 3 30 INSTALLED? /fo
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling K' Steep slope // - %Slope1.14
I SOIL NATURE: Sandx-- Loam/6/7T- Clay /14 Other/U/1.
✓ GROUNDWATER: At what depth? V7
I BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal r Well (If well: Water supply fro a y septic
system absorption is ft.)
I.
,Q I.
I PERCOLATION TEST: Rate is 7�' minutes per inch [MPI]
(Test to be mpleted 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:
❑ ABSORPTION FIELD.(WITH NO. 2 STONE) Total Iength2QO ft. Each trench p X Sc.9
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? A.,4_ Size? /U
❑ ALTERNATIVE SYSTEM Bed or other type? /V
❑ HOLDING TANK SYSTEM Total required capacity?
eZZ_______I
sti c
Tank size? L ) o d Number of tanks? /
I NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
I 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.
4 �
Septic Inspection Report
Office No. (518) 761-8256 Date Insp�ect `equest received:
Queensbury Building &Code Enforcement Arrive: 6'' T3 am/pm Dert: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: -AZ-- Ogg NAME: _ C/PERMIT NO.: 2Q/0— J g
LOCATION: INSPECT ON: -?-76P—/e:2)
RECHECK:
... Comments and/or diagram
Soil Ty.—
/ Loam/ Clay
Type of Water: Municipa /Well Water
Wate •- ration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length .
Length of each trench ft.
Depth of trenches '2- ft.
Size of Stone Z-
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank Cjc/.7p7
Tank to Distribution Box 0 2.-ef)
Distribution Box to Field/ Pit
Opening Sealed: )f N
End Cap
Inlet/Outlet Pipes&Baffles ✓Y_ N
Location/ Separations
Foundation to tank n/��4 ft.
Foundation to absorption ft.
Separation of Pits ` ft.
Conforms as per Plot Plan Y_ N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
Ss -m se
, .
�'Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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TOWN OF QUEENSBURYi k ikj TOWN OF QUEENSBURY
BUILDING & CODES DEPT to fv" BUILDINEPART
G DMENT
Based on our limited examination,compliance
,
• Reviewed By:_itViC) ----\„9-3 , indi
with our comments shall not be construed as
eindicating the plans and sp_e4Codec* tions are in
)0 full compliance with thA Rts of
--New-YEA State.. _
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