2010-110 iA TOWN OF QUEENSBURY
F.,001
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100110 Date Issued: Tuesday, December 11, 2012
This is to certify that work requested to be done as shown by Permit Number P20100110
has been completed.
Tax Map Number: 523400-301-017-0002-014-000-0000
Location: 5 CHEROKEE Ln
Owner: ERNEST & MARLO BARBOZA
Applicant: ERNEST & MARLO BARBOZA
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
T 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.
i `etillhook TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
/4N
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100110 Application Number. A20100110
Tax Map No: 523400-301-017-0002-014-000-0000
Permission is hereby granted to: ERNEST& MARLO BARBOZA
For property located at: 5 CHEROKEE Ln
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: ERNEST & MARLO BARBOZA
5 CHEROKEE Ln Septic Alteration Residential
QUEENSBURY, NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-110
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,April 07, 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 To• • eensb , - •d ' ,April 07,2010
SIGNED BY IV for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY r-; -I
j, -Z r;
TAX MAP NO. PERMIT NO. t O 1/1 PERMIT FEE'' 1% APR i 2 1O i 1J
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.
OWNER: 1v1 tqGe G- 66,3 Gt INSTALLER: at P e-aiS`�y�
u t, �; ci ✓
ADDRESS: CIA ct&v /A DDRESS: At) r7 trp �r� 2 st.//1.
PHONE NOS. PHONE NOS. 61 —
LOCATION
l —LOCATION OF INSTALLATION: G� keia-
NO.OF RESIDENCE INFORMATION:
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GR1NDEt
1980 or older � X 150 gallon per bedroom = INSTALLED? (1;
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED? /G"
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling k'' Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓
DOMESTIC WATER SUPLY: Municipal 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: /6'-r-) 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: i„'&
ABSORPTION FIELD (WITH NO. 2 STONE) Total length (9--6--/) ft. Each trench'34Z-) X
❑ 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.
' ' ' (/I':CO ) JO- /2__ Sda _,
77-/or
\ 1/7 .
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: 11 •/(p am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:( 1 r�+
NAME: r Z. , PERMIT NO.: /0 --110
LOCATION: aw, It • INSPECT ON: �/
RECHECK: �_
Comments and/or diagram
Soil Type: Loam/ Clay
Type of Water: u ' / Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length c_ t.> ft.
Length of each trench 0 ft.
Depth of trenches
Size of Stone 'Z
Seepage Pits: Number AI tik
Size:
Stone Size: _ 02,(... vt..A4_><2.-
Piping Size Type fi
Building to tank ��
Tank to Distribution Box /(fr. t 401,,gwz_vd_.Distribution Box to Field/ Pit `0 "��"
Opening Sealed: _NEnd Capf\YI,
_N
Inlet/Outlet Pipes &Baffles —Y N 71rZ ' C>�
Location/ Separations t
Foundation to tank ft.
Foundation to absorption /�—
Separation of Pits
Conforms as per Plot Plan fY
Engineer Report and As-Built T YNIY
Location of Systemoperty:
Front Rear Left Side Right Side Middle Front Middle Rear
S em Use
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
K h
1
,....,, i
4--------- \ i
I 1
`-•=4. (Sav'" 1
____,)
_.„1-__T-- _ --.....,
,
1 --.1 f j__
1
1
.
Jo !4•_______ '°Q k
\
\ -1
...... ..„„)
,
4' . , c- ..\-- ,
,
,),.'-' --- ', 1
i _,.....
16/J_ 3,-,
1 1 vs. -,.
,,,...,
3 1 i
33.I 0 ,......,..„ .
NIL
' I
of,
lAtes ----,,,,,.. 'f-;•, ,— --. ,r. .,
!,. , • • .
• _ - I
. i _ ..:,,; •. .-..:
. L______________ _ ' • ' -_' ..._.1
TOWN OF QUE '4 ,B 'if
i BUILDING & Coi:Y S i/EP
I ilf/,/
Reviewed By: ' , ii.a .
Date: _
Ir :
kik TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Ivo_ Community Development- Building&Codes (518) 761-8256
Inspections per Permit
Permit# P20100110
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
04/06/2010 Final Electric Septic Alteration Residential COMMONWEALTH ELECTRICAL
Approved 2010-110
04/08/2010 Septic Septic Alteration Residential CHARLES DYER Staff
Approved 2010-110
PARTIAL-provide final electric-ok to bury field
12/11/2012 Miscellaneous Septic Alteration Residential STAFF
Misc 2010-110
final elec.rec'd April 2010-permit never closed out-CC issued
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No... ....... .......Cert. NO ' 10203 Cut-in Card No.....................................
s
Owner.............. ......... .1.:..: s..° >:.:.. :.............,..............,.............,......,..........................,......... ....
Location.....d..........;f .... ......... .................................... .
r. ...{ ............. ..........'..........at t
Installation Consistingof.. ........................................� `....°� .�` '� , �'!.�'";� .,_�......
.............................................................................................................................................................I......................
..............................................................................................................................-...................................
......,.....
Installed By... f
:....: ........... ..::.... :.............................................Lie.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of makVfgFn Wections at any time, and if its
rules are violated,the Company shall have the right yre_V-1,1,...
e this certificate..,
Date...... .... ................................. - ..........................INSPECTOR....; 3"k"
Member N.F.P.A.,I.A.E.I.