2010-459 TOWN OFQ UEENSBURY
11,
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100459 Date Issued: Tuesday, September 21, 2010
This is to certify that work requested to be done as shown by Permit Number P20100459
has been completed.
Tax Map Number. 523400-309-014-0001-028-000-0000
Location: 32 PINE St
Owner. TARA VISE
Applicant: JEFF GREGORY
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 1
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
ET
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100459 Application Number. A20100459
Tax Map No: 523400-309-014-0001-028-000-0000
Permission is hereby granted to: JEFF GREGORY
For property located at: 32 PINE St
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: TARA VISE
32 PINE St Septic Alteration Residential
QUEENSBURY,NY 12804-0000 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
2010-459
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, September 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 T ee uIJ�J r': , 'eptember 17, 2010
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
j Revised 4/14/2010
OFF U E� Y I.-2__?-
TAX ��
�AP NO. PERMIT NO. _411_fi ERMIT FE
Icy
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.
-7 OWNER: / 6 i P_ o r "/ INSTALLER: �j i liv,C- .C(iaic C /�/
ADDRESS: it 3Q e A-£ c✓ `l ADDRESS: 1 �— (OCA„..e• !' v /f/_c S / (Q (,
C 1461-87113PHONE NOS666 " ,y /
PHONE NOS. ?9 0 —r 4
l
LOCATION OF INSTALLATION: SU i\--C CA- 5a‘;-%-e
RESIDENCE INFORMATION:
YEAR BUILT
NO.OF COMPUTATION
X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older 3
X 150 = (� 9 INSTALLED? ��
SPA OR HOT TU
1981 -1991 X 130 = L J
1992-present X 110 = INSTALLED? -
PARCEL INFORMATION: �/
✓ TOPOGRAPHY: FLAT ROLLING /c STEEPP^SSLLOPE/A- %SLOPFO4
I SOIL NATURE: SAND n LOAN((/1 CLAY____ ' OTHER kfil
✓ GROUNDWATER: AT WHAT DEPTH? Am
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? �A
I DOMESTIC WATER SUPLY: MUNICIPAL< WEL (If well:water supply from any septic system absorption i?!(//41-ft)
I PERCOLATION TEST: RATE IS 4. PER MIINUTE PER INCH[mpi]
(Test to be comp) ted b 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: Li y(f s Ti rGALLON(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 length )6(,) ft. Each trench r� XS
4/71-❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? V A//4ISize? (
❑ALTERNATIVE SYSTEM Bed or other type? 4/1o HOLDING TANK SYSTEM Total required capacity?N I4 Tank size? /VA 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 abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewag Disposal Ordinance.A., 2/4/Jcodes(d�queensburv.net
-- G 0`(I VISIT OUR WEBSITE FOR MORE INFORMATION
WWW
Sign e o Person Responsible Date •uueensburv.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
Ink
(ii ,cc) 1
a
Septic Inspection Report
Office No. (518)761-8256 Date Impaction req ;;,..- 1111.4.- -,••• 'ed•
Queensbury Building&Code Enforcement Arrive: \ '"1.A a- /':- -: : \�, am/, '
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial, ��
NAME: 3 (2..
i41 ` �J NO.: /offLOCATION: i. �,d f/ � ON: ' . Air
—
RECHECK:
Comments and/or diagram
Soil Ty gym Clay
Type of Water M e Water
Waterline separation distance C) 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 lengthO ft.
Length of each trench 7�(�i'/Z 1�t'_ ` . •?,i Gto
Depth of trenches 117—'L ft.
Size of Stone y4?/
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type V.pitz-<tic7
Building to tank 1-{`, , � �
Tank to Distribution Box
Distribution Box to Field/ Pit k,,V
Q c� "cc> QE D
Opening Sealed:
End Cap N
Inlet/Outlet Pipes&Baffles _N
Manholes 12"or less below grade Y N
[provide extension collar if Yes] Y_N
Location/ Separations
Foundation to tank k. .
Foundation to absorption ,r ft.
Separation of Pits / ft.
Conforms as per P P . •la _N
Engineer Report and Bui Y N
ETU Maintenance •n.r _Y_ N
provided
Location of System on Property:
Front Clio Left Side Right Side Middle - Middle Rear
system Use Sta_ s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
l:\Pam Whiting\2010\Buiiding Codes Forms\Inspectlon Forms\Septic Inspection Report_03 2910.doc
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