2010-589 TOWN OFQ UEENSBURY
worio
742 Bay Road Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100589 Date Issued: Thursday, January 06, 2011
This is to certify that work requested to be done as shown by Permit Number P20100589
has been completed.
Tax Map Number. 523400-309-018-0001-016-000-0000
Location: 55 TWIN CHANNELS Rd
Owner. MC CAULEY JOHN
Applicant MC CAULEY JOHN
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 // p p
owner of the responsibility for b ' /`` /7//`
property p ty o compliance with Site Plan, .. ,
Variance, or other issues and conditions as a result of approvals by the o"
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
FOS 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100589 Application Number. A20100589
Tax Map No: 523400-309-018-0001-016-000-0000
Permission is hereby granted to: MC CAULEY JOHN
For property located at 55 TWIN CHANNELS 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 Constmction Value
Owner Address: MC CAULEY JOHN
55 TWIN CHANNELS RD Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2010-589
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, December 30,2011
(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 Tcriirdfq!leensilCiuyy , December 30,2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
0Community Development Office , ,7j�i
— Town of Queensbury • 742 Bay Road • Queensbury, New York •1:2804 {
Office Use Only I
TAX MAP NO. 30 7.8-/ /6 PERMIT NO. /0.- - 7PERMIT FEE - -' (#�`
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE VI'
BEGINS.` '� APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: --Vo Yk N ' MC- C-14ut ey INSTALLER: fig " ' T 4,L7 IL) e,f___,jet-t C C _
ADDRESS: 5- S w.u L. A ii-'03•J e L /�S ("� ADDRESS: P 10 30 K- 2:2.-Lt / 4 r
PHONE NOS. PHONE NOS. 96 —O F crJ
LOCATION OF INSTALLATION: ST 76). N ej h.; N N t-C.! `2)
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRI R
1980 or older X 150 = 3z:J INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? �''
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
I DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpg (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: 1 OO' 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:
o ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
o SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
sieLALTERNATIVE SYSTEM(-Bed or other type? 2°1 JC `� '
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.
I have read the regulations with respect to this application and agree to
y these ... : -quirement of the Town of Queens ury QUESTIONS? CALL 761-8256 OR EMAIL
ni ry Sews, Di ,� •al Or ce. i j2,9 `O codes(a�queensbury.net
g iature of Pe o/rf Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ Depart:0 am/pm
742 Bay Rd., Queens ury, NY 12804 Inspector's Initials: A. .
NAME: IL i i k,, /V) S ?7
�� PERMIT NO.: /
LOCATION: �c- /c,";, ((Na ,1,,�t/S ( INSPECT ON: /;?
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, . . 0 ,7
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. : n or observed, or believe I saw evidence ofI,
.,H,.:c;t:s such as houses, wells, trees, fences, etc., 1 .
on this document. I also represent that I have
-F,1,?jiy rne,.. ,,-.: ',' the dis.,:: .ces set fcrth on he dia ram." #,
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