2015-147 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150147 Date Issued: Wednesday, May 20, 2015
This is to certify that work requested to be done as shown by Permit Number P20150147
has been completed.
Tax Map Number: 523400-308-017-0001-047-000-0000
Location: 4 TINA Ln
Owner: GEORGE & CAROL SCHNEIDER
Applicant: GEORGE & CAROL SCHNEIDER
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 (DJ 4
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
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Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150147 Application Number: A20150147
Tax Map No: 523400-308-017-0001-047-000-0000
Permission is hereby granted to: GEORGE & CAROL SCHNEIDER
For property located at: 4 TINA Ln
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: GEORGE& CAROL SCHNEIDER Septic Alteration Residential
4 TINA Ln Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
BP 2015-147
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,May 08, 2016
(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 n of eens i s4 y 08,2015
i
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT
Office Use Qnly
/ �y ryp�p
DATE •' dID I.. , , MAY U 8 LVTJ'ivedi u
Tax Ma '3ob . 1I. - 44
TAX MAP ID �� (7- (-4 • a Na- Permit: . '017-/Y-7
/ -� BUILDING Permit Fee 4 Lib, Ud
LOCATION OF INSTALLATION 1i' �l Approvals:
APPLICANT 120 ✓` r C J . Sr/Ike/ de r- PHONE/E-MAIL
ADDRESS / i iv C!f-'`� Gr��s�C-�4zeY
/i
INSTALLER/BUILDER: ti`a 4-13 j eiti_it'i7 fe r v/c PHONE/E-MAIL 7Y02 - 72 1-2
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DR �:,C zz G/e -i- /fc
ADDRESS: PD . U
�
//� r1"- J Se'4 n/t. ch f'
OWNER (liar PHONE/E-MAIL
Address y I , tea- (4-1`C
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: l 7-ec r jJ 2 bp-e-ffoy PHONE(/ -5 /6U
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed _Y 4 N
1981-1991 Spa or Hot Tub installed _Y �N
1992-Present 3 //c) 3 30
PARCEL INFORMATION
Topography ;V Flat rolling Steep slope %slope
Soil Nature , Sand Loam Clay Other
Groundwater At what depth? t'4
Bedrock/Impervious Material At what depth? ' /-3
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: /- c per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size //lazy gallons(minimum size 1,000 gallons, add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length ft.;Each trench x
Seepage Pit with#3 stone How many: ;size
X- Alternative System Bed or other type? -a 0/ btr L 1
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received &approved. The Installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to abide t3y these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: 6-e c� G' k-f Date: S - i-/ s
Signature: '� --- Date: 5-f - / s-
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
Town of Queensbury Building & Code Enforcement 144b& 11'11'1 ✓v i 2.---
Office No. ( 18) 761-8256 1
Septi Inspection Report
Inspection request received: S '' I S
Name: S(A)ft.e., r.-tr V- Inspected on: '(161 1 ✓
Location: ` ,.)k i-- Arrive: Ii►ei M-.m.
1
Permit No.: .E -- 7 Inspector's Initials: ��•_''
Com.-ents and/or diagram
Soil Typ oam/Clay
Type of Water: Municipal/ ell Wa
Waterline separation distance ft.
Well separation distance \f.)G ft.
Other wells: . ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length 95 ft.
Length of each trench )-1 Q'2 ft. gPp 'Gcs
Depth of trenches 2- , ft.
Size of Stone .AZ
Seepage Pits: Number
Size: x FF (" F-,.: T 7
Stone Size:
Piping Size Type
Building to tank F kt-th-t% 6 \-0
Tank to Distribution Box W'\ 3-3C09-3—
Distribution Box to Field/Pit6p� ?o y" �c:5- va,F
Opening Sealed: N
End Cap Y J•V' 7
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade vY/ N/
[provide extension collar if Yes] Y ✓N
Location/Separations
L? Foundation to tank `\ ft.
•
Foundation to absorption VI ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of S stem o ' ose: : -
Front '-� �LeftSi. 'ight Side Middle Front Middle Rear
ystem Use Stat :
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report (-:
i
Town of Q;ieensbury Building & Code Enforcement 113O
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: GEORGF i b2) Inspected on: —Z —_
Location: + J\ VAN * F Arrive: .1g ' p.m.
Permit No.: S-ti p t Inspector's Initials:
t5-1l(0--79 376)0 Co ' - s and/or dia•ram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water \ ,F‘3, 0--\-- 4
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft. 'I G E-D VtF I
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 Y N
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 provided Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
pproved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report