2013-147 TOWN OF QUEENSBURY
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742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130147 Date Issued: Thursday, April 18, 2013
This is to certify that work requested to be done as shown by Permit Number P20130147
has been completed.
Tax Map Number: 523400-308-005-0001-077-010-0000
Location: 131 LAUREL Ln
Owner: CHRISTINE DEE
Applicant: CHRISTINE DEE
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 thed4if•
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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130147 Application Number: A20130147
Tax Map No: 523400-308-005-0001-077-010-0000
Permission is hereby granted to: CHRISTINE DEE
For property located at: 131 LAUREL 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: CHRISTINE DEE Septic Alteration Residential
EDWARD HINES Total Value
131 LAUREL Ln
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans&Specifications
2013-147
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,April 17,2014
(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,Queen ury; ed • s a .,April 17, 2013
SIGNED BY `� f for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 QNR 6 2013
Office Use Only �f h 1�
TAX MAP NO. 3b g .3-i- ii PERMIT NO. 13— I l / PERMIT FEE ' /Ds t74
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION $ SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: C 41 /'I r(- C 2( ' 416:ST):kLLER: -mss
ADDRESS: # , 3 ' ( Lk() r L l ADDRESS: L ,.A�,''<Q— w,Ne_z_e 1N 4 I EF 1
PHONE NOS. ci y- 3 1 ' 0/ } 3 PHONE NOS.
LOCATION OF INSTALLATION: r2, I 'L\vim L \ S
RESIDENCE INFORMATION:
NO.OF COMPUTATION = TOTAL DAILY FLOW
YEAR BUILT BEDROOMS X (Gallons per bedroom) GARBAGE GRINDER
1980 or older
(i X 150 0 INSTALLED? //O
1981-1991 X 130 a SPA OR HOT NB
1992-present X 110 mgINSTALLED? �,.?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT RO NG K STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?A 1 p}
✓ BEDROCK/IMPERVIOUS MATERIAL: AT W J T DEPTH?A/f\
I DOMESTIC WATER SUPLY: MUNICIPAL WELL_ (If well:water supply from any septic system absorption is: ft)
I PERCOLATION TEST: RATE IS 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:(v D 0 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. C r / S;i Ai
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length 5 U ft. Each trench X )
❑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 e regulations with respect to this application and agree to
abide by th s= and all requirements e Town ofre sbury QUESTIONS? CALL 761-8256 OR EMAIL
S.•• :ry S• 'age Disposal Ord aan /) j 0 j 3 codes(a)oueensburv.net
re of Person Res o�nsib a Z Date I VISIT OUR WEBSITE FOR MORE INFORMATION
P www.queensburv.net
W J esd at Er- a pm
Septic Inspection Report
Office No. (518) 761-8256 Date Ins _ ion u:1 - v-•
Queensbury Building &Code Enforcement Arrive: 1 : /,i., a (pu -•.. ' : c: amp)
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: ! P 1c, kQIi. ) PERMIT NO.: / 3 --191-1
LOCATION: / 3 / kJ INSPECT ON: / 9-43
RECHECK:
Comments and/or diagram
Soil T •:: Sa .. •:m/ Clay
Type of Water/600 / Well Water
Wat- separation distance VQ ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length y.6i) ft.
LengthDepth of trenches 7_ ft. k '%'vi ii
Size of Stone ti,N
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank i-1 I /7C t -tU Ey - 1 i I
Tank to Distribution Box
Distribution Box to Field/ Pit " J L TC: t kc %);_k-?_N\--;14__4
Opening Sealed: -N
End Cap N
Inlet/Outlet Pipes &Baffles N
Manholes 12"or less below grade _Y—N
[provide extension collar if Yes] Y
Location/ Separations
Foundation to tank 1C) ft.
Foundation to absorption T- ft. AS BUILT
Separation of Pits
Conforms as per Plo tan N
Engineer Report an -Built Y N
ETU Maintenance _Y_ N
provided
Location of System on Property:
-
Front ar Left Side Right Side Middle Frog Middle Rear i
S stem Use S tus:
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 PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS \ APR 1 a 2013
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY (' 0
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TOWN OF QUEENSBURY (' ' it.
BUILDING & • • :�/i►: T, u
Reviewed By. �;ff/� V`Jl
Date: //Ma 0 6 II