2010-580 . � TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20100580 Date Issued: Thursday, December 27, 2012
This is to certify that work requested to be done as shown by Permit Number P20100580
has been completed.
Location: 22 RIVER St
Tax Map Number: 523400-309-014-0001-062-000-0000
Owner: JOSEPHINE JULIANO, TRUSTEE
Applicant: JOSEPHINE JULIANO, TRUSTEE
This structure may be occupied as a:
Septic Alteration Residential By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy 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 Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
� ` TOWN OF QUEENSBURY
`4 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100580 Application Number. A20100580
Tax Map No: 523400-309-014-0001-062-000-0000
Permission is hereby granted to: JOSEPHINE JULIANO, TRUSTEE
For property located at: 22 RIVER 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: JOSEPHINE JULIANO, TRUSTEE
JOSEPHINE A. JULIANO TRUST Septic Alteration Residential
22 RIVER St Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
BRADLEYS SEPTIC
654-6318
47 HACK Rd
CORINTH, NY 12822-0000
Plans &Specifications
2010-580
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, December 22, 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 Town of Queensbury; Wednesday, December 22, 2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010
OFFICE USE, /. .
I C1. f t -5. -
TA VIA N PERMIT NO. ERIb11T FEE
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 VA ID PERMI.
i
OWNER: t A INSTALLER: `14
ADDRES : Z J ADDRESS: " 7 7 l m G-1./° i --
PHONE NOS. 636, -3 , z 2 PHONE NOS. 54 0 3 /g-
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
• 1980 or older y X 150 = INSTALLED? N
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? jV ()
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING (/ STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL f WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MINUTE PER INCH[moil
(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 installedllin a Planning Board approved subdivision).
TANK SIZE: /0 Uk) 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: `�r1/1 �j
El ABSORPTION FIELD(WITH NO.2 STONE) Total length /4 6) ft. Each trench L- X 2--
❑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 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
•e Disposal Ordip codesqueensburv.net
AY� �V— l VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date
www.queensburv.net
Town of Queensbury* Co munity Development Office * 742 Bay Road, Queensbury NY 12804
sT &ruNS
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: // '�,__ am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ( � (T�'j—
NAME: _1(3 PERMIT NO.: /6--(.5-
—�g-1).
LOCATION: e r- INSPECT ON: VZ-
RECHECK:
ZRECHECK:
Comments and/or diagram
Soil Type: Sand / Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline separati• •istance ft.
Well separa on istance ft.
Oth:r wells: ft.
Well Casing Le ith '0' + / - J Y N N/A
[150'to we require' if NO] J
Absorption "field: Tota lengt ft.
Le ,•th of each tren• ft.
Depth of tr•nc -s ft.
Size o'Stene
See .ge Pits: N ber
"L71/4. (Z 1 CIS
.ize: x � `
Stone ize: ti �t'��?-�
Pipin; Size Type ( L
Build ng to to k J l
Tank to Distri ution :•x
Distribution Box to field/ Pit
Openin• Se. ed: Y N
En• Cap _Y N / —t�t----L-s34.-OP
OP
Inlet/Outlet Pipes : ;affles Y
Manholes 12"or less below grade _Y_ N j PU
[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 R- . Left Side Right Side Middle Front Middle Rear
System Use Sta. s•
Appro
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 Inspection request received: /- l ,0 10
Queensbury Building &Code Enforcement Arrive: am/pm Depart: rani am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: .I
NAME: -.71-76) '-�,"�"`v(�'i�4 ' 1-4 "6" PERMIT NO.: O i O -3 'b
LOCATION: .a. i v-. St INSPECT ON: ' AM 1
RECHECK:
a
(els �____,
Comments and/or diagram
Soil Type:ge,e(
Loam/Clay
Type of Water: Municipal / Well Water
Waterline separation distance ft.
Well separation distance / �J ft.
Other wells: _ ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length i g/0 ft.
Length of each trench t�61 ft.
Depth of trenches ,'V-r' ft.
Size of Stone 0 .
Seepage Pits: Number1
141i-
Size: x
Stone Size: ,
Piping Size Type 01-VS- -14----1€01"
Building to tank ---
Tank
rTank to Distribution Boxr>Q- 3(
Distribution Box to Field/ Pit `� S172-1 C
Opening Sealed: _ N 2. '`'/ c\L e 41
End Cap Y_ N
r
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade Y— N �
[provide extension collar if Yes] TY_ N 1� .
Location / Separations
Foundation to tank ft.
Foundation to absorption AQ ft.
Separation of Pits ft.
Conforms as per Plot Plan N
En nd As-Built 'Y N
ETU Maintenance Contract _ _ N
provided
Location of System •• Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use.
AIM Approved
r 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 Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pjmDe rt: t.✓ am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: /I
k �
77-5°E0NAME: 4J U �,( �T PERMIT NO.:
LOCATION: ,?Z INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ 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 NOl
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
&A,N.Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit b. t.
Opening Sealed: _ N
End Cap VY N .
Inlet/Outlet Pipes&Baffles Y N • Oftei".. kz.,„sot C>C2_,C)
Manholes 12"or less below grade _Y_ N
[provide extension collar if Yes] Y Nf(21
Location/ Separations
Foundation to tank ft.
Foundation to absor'bon ft. 49.
Separation of Pits ft. 'V.::
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 f Rear Left Side Right Side Middle Front Middle Rear
S stem Use Sta _
ro d
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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TOWN or UUttN bUnr
BUILDING DEPARTMENT r L
TOWN OF OUEENSBURYBased on our limited examination,compliance -,
with our comments shall not be construed as ,
BUILDING & CO ES DEPT. indicating the plans and specifications are in r
`" full compliance with the Building Codes of — %
Reviewed By: `-- New York State.
Date: 7--- , v -