2010-272 ..4111hi TOWN OFQ UEENSBURY
wow
742 BayRoad, NY 12804-5902761-8201
Queensbury, (518)
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100272 Date Issued: Tuesday, June 08, 2010
This is to certify that work requested to be done as shown by Permit Number P20100272
has been completed.
Tax Map Number: 523400-289-009-0001-057-000-0000
Location: 317 GLEN LAKE Rd
Owner. DOROTHY ZEMANEK
Applicant DOROTHY ZEMANEK
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 /
41'
property owner of the responsibility for compliance with Site Plan, I
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
Fors 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100272 Application Number. A20100272
Tax Map No: 523400-289-009-0001-057-000-0000
Permission is hereby granted to: DOROTHY ZEMANEK
For property located at: 317 GLEN LAKE 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: DOROTHY ZEMANEK
317 GLEN LAKE Rd Septic Alteration Residential
LAKE GEORGE,NY 12845 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
QUEENSBURY SEWER
NY 12804-0000
Plans &Specifications
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,June 04, 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 own Que 13;7; F/• . une 04,2010
SIGNED BY ` for the Town of Queensbury.
Director of Building&Code Enforcement
jOFFICE USE ONLY 1
TAX MAP�N PERMIT NO. D / ERMIT FE' IC
,' `"
C�� Q7-?
APPROVALS: ZONING TOWN CLERK ' `
1(� i
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A YAIiR
PERMIT.
OWNER: Z*Q !! INSTALLER: e- r
ADDRESS: . / 2 /
/, ADDRESS:
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GIINDE
1980 or older )< X 150 gallon per bedroom = L,l c ) INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TU
1992-present X 110 gallon per bedroom = INSTALLED?�O
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling y Steep slope . %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal Well X (If well: Water supply from any septic
system absorption is eye r / f8
✓ PERCOLATION TEST: Rate is / -S----- 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: ,/n15`-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:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
O 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.
• +4 - 9 oc
Septic Inspection Report
Office No. (518)761-8256 Date In 6 :cr r:-A6-;•41-•-iv-•.
Queensbury Building &Code Enforcement Arrive: U �% part: '-
742 Bay Rd., Queensbury, NY 12804 Inspecto s Initials. _
NAME: 9�C1f� P IT NO.: 1 '"Z7 a
LOCATION: v3 1 7 -EA\ LRt _FI PECT ON: --fO
RECHECK:
Comments and/or diagram
Soil Type: Samoa Clay
Type of Water: Municipal/ ell W
Waterline separat' nce ft.
Well separation distance 5 'j"rft. --c-t) •��-�,; ,b G ,�J —
Other wells: RIO" ft.
Well Casing Length 50'+/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length , ti
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number t % -t--\
Size: x
Stone Size:
Piping Size Type
Building to tank I- 1 � k-kC
Tank to Distribution Boxt �pGZ-'�� \C ;��,�
Distribution Box to Field/ Pit
Opening Sealed: Y N
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 % Jft.
Foundation to absorption ft.
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:
Fro •-ar eft Side •ight Side Middle Front Middle Rear
stem 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 Forms\Inspection Forms\Septic Inspection Report,,.03 29 10.doc
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Septic Inspection Report
Office No. (518) 761-8256 Date Ins.- ion -• - re,;ved•
Queensbury Building &Code Enforcement Arrive: krjkpm •.rt: V;,71) am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial- 44&-.
NAME: '�'Eta R ituE P RM NO.:
LOCATION: t INS' CT ON: E-1 -- te)
RECHECK: 'Trott.': RE__Pc_'t(_EM E'en
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft.
Well separation distance ft. UcA
Other wells: ft.
Well Casing Length 50'+/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size: ,
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: _Y—N
End Cap YN
Inlet/Outlet Pipes&Baffles Y_N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] ..__Y—N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
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:
Front Rear Left Side Right Side Middle Front Middle Rear
st-m Use Status
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Formson Forms\Septic Inspection Report 03 2910.doc
RPS Property Description Report Page 1 of 3
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ueensbury
New York
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289.9-1-57 * 317 Glen Lake Rd
Parcel Information:
Parcel Location Acres Property Class School District
289.9-1-57 317 Glen Lake Rd 0.38 1 Family Res Lake George Csd
2010 Assessment Values:
Parcel Assessed Land Value Assessed Total Value
289.9-1-57 26,400.00 207,000.00
Image Date: 6/24/2004
Owner Information:
Owner Owner Address P.O. Box Owner Address Line 3
Dorothy Zemanek 317 Glen Lake Rd Lake George NY 12845
Site Information:
Site Site Nbhd Nbhd Road Entry Zoning
Nbhd Code Sewer Water Utilities Desire Type Rating Type Type Code
1 106- Private Private Electric Typical Suburban Average Improved Inter WR
Rt9L,Eside,Sunn Inspec
http://gby2 svr/gis/RPS_INFO2.ASP?printkey=289.9-1-57 6/1/2010
RPS Property Description Report Page 2 of 3
Land Information:
Site# Land# Type Front Depth Acres Sq Ft
1 1 01-Primary 128 128 0 0
Building Information:
Site# Bldg Style #Stories Ext Wall Mat Yr Built #Kit. #Baths #1/2 Baths #Bedrm #Firepl
1 Log Home 1.5 Wood 1946 1 2 0 4 0
Site# Heat Type Fuel Type Central Air Bsmt Type Overall Cond Constr Grade SFLA
1 Hot Air Oil No Partial Normal Average 1800
Improvements Information:
Site# Struct Code Dim 1 Dim 2 SQ FT # Constr Grade Overall Cond Yr Built
1 RP4-Porch-enclsd 10 24 0 1 Average Normal 1960
1 RG4-Gar-1.0 det 15 23 0 1 Average Normal 1960
1 RP3-Porch-screen 12 19 0 1 Average Normal 1979
Special Districts Information:
Special District Units Percent
EM001-Emergency medical 0 0
FP007-Fire protection 0 0
LB001-Crandall library dst 0 0
RPS Building Permit Information:
Permit Number Permit Date Permit Use Cost Estimate
P94-544 09-28-94 Addition 0.00
P1332 07-26-71 Home Office 20,000.00
The RPS codes used in this report are defined here
Need Help printing this report?
The information in the RPS database is maintained by the Town of Queensbury Assessors Office
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Town of Queensbury-742 Bay Road-Queensbury,NY 12804-(518)761-8200
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Albany County DSS Page 1 of 2
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