2012-328 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: P20120328 Date Issued: Tuesday, July 10, 2012
This is to certify that work requested to be done as shown by Permit Number P20120328
has been completed.
Tax Map Number: 523400-308-016-0001-021-000-0000
Location: 12 STEPHANIE Ln
Owner: ADAM POWERS
Applicant: ADAM POWERS
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 thecl—)a.v7-(1
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property owner of the responsibility for compliance with Site Plan,
V
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
` • 742 Bay Road,Quccnsbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120328 Application Number: A20120328
Tax Map No: 523400-308-016-0001-021-000-0000
Permission is hereby granted to: ADAM POWERS
For property located at 12 STEPHANIE 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: EDWARD & SUSAN MC CARTHY
12 STEPHANIE Ln Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
QUEENSBURY,NEW YORK
Plans&Specifications
2012-328
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 09, 2013
(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 f Que sbu / J M tL I a' . • 09, 2012
/
SIGNED BY 14h, for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only
7
36 8• i to-/-d. I PERMIT NO. SiD PERMIT FEE JUL 6 t�z
TAX MAP NO. d. '
APPROVALS: ZONING TOWN CLERK,__
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT M BE OBTAINED
BEFORE W•RK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: \ UM pOu' ?C ) INSTALLER:4?S �/�
ADDRESS:' III \ i__- 4 �1�IJ�1 Lr . ADDRESS:A4,±
j�W( P(�( " O((P��i
PHONE NOS. 1 1,)`0•8 { 1 PHONE NOS. 1t� U\ 1 9-
LOCATION OF INSTALLATION: 1 5` V�(I,(Nt c L t, ,
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = - INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION: \I \�
✓ TOPOGRAPHY: FLAT ROL NG STEEP SLOPEN
V N %SLOPE Y 1" ,I
✓ SOIL NATURE: SAND LOAM\V CLAY \ f} OTHER IV 1V✓ GROUNDWATER: AT WHAT DEPTH? N N
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WH T DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL I\I (If well:water supply from any septic system absorption is: IV
A" ft)
✓ PERCOLATION TEST: RATE IS N it PER MIINUTE 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: i1 00 GALLON(MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlp of tub...F,c S} 7
SYSTEM T PE: ( ,_
ABSORPTION FIELD(WITH NO. 2 STONE) Total length 10n ft. Each trench,r �i X 0
❑SEEPAGE PIT(S)(WITH NO. 3 STONE) How many?` r N? Size? IV k
❑ALTERNATIVE SYSTEM Bed or other type? `V k\
❑ HOLDING TANK SYSTEM Total required capacity? \v !k 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 b these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanit �a ge Disposal Ordinance. �� � codes(a�queensbury.net
Sig re Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
tkesd« 1-3 C1m>
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection reque 1' wed:
Queensbury Building &Code Enforcement Arrive: I2.=56 am 474 D-=•rt: r =O 0 a v pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: I tm.
NAME: p__ck in P0 LU ers P •MIT NO.: I a `3 ,AY
LOCATION: cc()CP. n SPECT ON: 17-1 -'!A
RECHECK:
daft Comments and/or diagram
Soil T •- Mit •am / Clay
Type of Wate • Munici•a ell Water
Water) - - ion •istance c, T'AOft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A AS BUILT
Absorption Field: Total length ft.
Length of each trench �l � ft.
Depth of trenches j'? —2q"ft.
Size of Stone '—
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
E T‘ 1- Building to tank L1 `) Lti{ '4D
Tank to Distribution Box 4 " 'Q J C_
Distribution Box to Field / Pit / 41-( QAC z o PER_F
Opening Sealed: ✓ _N
End Cam_ N
Inlet/Outlet Pipes &Baffles I/Y— N
Location/ Separations / - €VA 4 fl
• Foundation to tank 9 ft.
Foundation to absorption 2 .
Separation of Pits / ft.
Conforms as per P Plan N
Engineer Report an As-Bu� /Y N
Location of System on Property:
Front •-ar eft Side Right Side Middle Front Middle Rear
S -I s- .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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BUILDING & 0b %'' rts V`'
Reviewed By %d
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