2010-327 TOWN OFQ UEENSBURY
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742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100327 Date Issued: Tuesday, December 11, 2012
This is to certify that work requested to be done as shown by Permit Number P20100327
has been completed.
Tax Map Number: 523400-288-000-0001-070-000-0000
Location: 1207 WEST MT. Rd
Owner: JAMES DEE
Applicant: JAMES DEE ESTATE
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 f�
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
`0 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
01
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100327 Application Number. A20100327
Tax Map No: 523400-288-000-0001-070-000-0000
Permission is hereby granted to: JAMES DEE ESTATE
For property located at: 1207 WEST MT. Rd
in the Town of Queens bury;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: JAMES DEE ESTATE
C/O PATRICK DEE Septic Alteration Residential
22 CEDARWOOD Dr Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-327
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,July 07, 2011
(If a longer period is requited,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.ft VIVOIsjilLy,July 07, 2010
SIGNED BY it)All/ "� /' for the Town of Queensbury.
Director of Building&Code Enforcement
g
OFFICE USE ONLY •
zsi- -- /-- �a o ;
N^3z�PERMIT —
•
TAX MAP NO. PERMIT NO. FEE •
APPROVALS: ZONING TOWN CLERK •
1 •
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: a ) k I c K PNSTALLER: Si-)S 1-:Z.4,ov p A-C',K E S Co tV S 'l C.
A .-22 0 C S a y• N,, , �v a)7 S C L•U e ; I
DDRESS:
I�,�/< c )] C4 ADDRESS: 777/ /`1 J J\J ) /oZ r�
Q u p wYEDi?K - A) y / -�� / y
PHONE NOS. 17 F E--/6 '/5 PHONE NOS. s'1 a -L/a .5-7 - / 3--_
LOCATION OF INSTALLATION: C' 4 �T , ��G�
YEAR BUILT NO.OF X COMPUTATION= RESIDENCE INFORMATION:
BEDROOMS = TOTAL DAILY FLOW
1980 or older 3 X 150 gallon per bedroom = �` GARBAGE GRINDEF�
`C INSTALLED? c2
1981 -1991 X 130 gallon per bedroom =
1992 present X 110 gallon per bedroom = SPA OR HOT TUB
INSTALLED? N d
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling K Steep slope %Slope
✓ SOIL NATURE: Sand )( Loam
Clay Other
✓ GROUNDWATER: At what depth? -A/0/V E_
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? p v c
✓ DOMESTIC WATER SUPLY: Municipal x Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is ) -Jti1ir\) q 5;e:Qper minute per inch.
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal ystems must e designed yl
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision).
TANK SIZE: /00D GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of the septic tank for
v is,-4-bu each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length - OOft. Each trench ,570 X .V
❑ 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
•
L WORKK 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.
SITE DATA
PROJECT LOCATION: 1207 WEST MOUNTAIN ROAD, QBY NY 12804
ZONING: MODERATE DENSITY RESIDENTIAL (MDR)
SETBACKS: FRONT-30 FT
SIDE-25 FT
REAR-30 FT
MAXIMUM BLDG HT: 40 FT
MINIMUM PERMEABILITY: 50%
SEPTIC SYSTEM DESIGN INFORMATION
SOIL TEST DATA:
PERCOLATION TESTING:
PT#1 STABILIZED RATE 1 MIN 03 SEC PER INCH
PT#2 STABILIZED RATE 1 MIN 08 SEC PER INCH
COMPLETED ON: APRIL 19, 2010 BY: VISION ENGINEERING, LLC
DEEP TEST HOLES:
DEPTH: TYPE:
TH#1 0-8" TOPSOIL
12-42" ORG BRN LOAMY FINE SAND
42-80" GRY BRN MED-CRS SAND
NO GROUNDWATER OBSERVED IN TEST HOLE
NO MOTTLING OBSERVED IN TEST HOLE
NO IMPERVIOUS OR BEDROCK OBSERVED IN TEST HOLE
COMPLETED ON: APRIL 19, 2010 BY: VISION ENGINEERING, LLC
Ilk .- _, ( 32( $ 3c ) k
7
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm rt:3 1?.c.)am/pm
742 Bay Rd., Queensbury,bce),:e_.--
NY 12804 Inspector's Initials:
NAME: J `�j � PERMIT NO.: /0 — -32_7
LOCATION: /207- / k �T. +�'t INSPECT ON: ' --j_7-l(7
RECHECK:
�� Comments and/or diagram
Soil Type:Cede'/ Loam/Clay
Type of Water: Municipal/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 1..4.--t) ft.
Length of each trench 0 ft.
Depth of trenches —k.1/4- l:
Size of Stone A `Z �LI�� t���
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type ��(�, _- +-,��7
Building to tank F�1�
Tank to Distribution Box `i
Distribution Box to Field/ Pit '511111__
Opening Sealed: Vx "N
End Capki �N
Inlet/Outlet Pipes&Baffles Y_N
Manholes 12"or less below grade _N
[provide extension collar if Yes] r/Y_-_ N
Location/ Separations
Foundation to tank t' c ft.• ' t- 1
Foundation to absorption r+k" ft.
Separation of Pits .'/ ft.
Conforms as per Plot Plan /� —N
-Built Y N '-2____ 5 --
ETU Maintenance Contract _Y_ N0_____A-1-ike---6 provided
Location o S stem on Property:
Front R Left Side Right Side Middle Front Middle Rear
stem Use Stat •
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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