2013-208 ('r�i `�+�� -�61-8201
1&f-JS S13A30 6
.��� A 5942 �518�
►�(� °des
Ueensbn�' '$ c
Bay ad,Q. Uilding St �Y
cxv-v,.pevelop�'ent rIVI
ar p13 my 1p,Z esaay' �
to js
L �Da 3p�,08
p�,01
�'Zp13pZp8 exrnit�nnber
1'er�t.�umbex• one as shown by P
regUestetl
to be d p0
phis is to Certify that`'pork rOoa1_01l'�p4_00
been coxriPleted. 523 ID.
has amber; ��
,.T�N1aP 12CCA�F'C�A�o
Avg
of o f QBE SsB-00
By°xdei �
Applicant: ay be oeevpieJ)
s struet`'xe n' Residential & Co
tiode gnfpzcen'ent
alteran S �ve the of Bnld�ng eptic S ��� retie plans DitectOx
-Do Site by th e
to of C°YnPhfoce
rccom4lianit of�appro�'als
dace of this off trey x sP°n5 dna tions as a xesU
1st Qert�'
OWTje
other issues auDoard of APpeals
Variance,hoard or Zon' g
planning
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130208 Application Number: A20130208
Tax Map No: 523400-289-011-0001-017-000-0000
Permission is hereby granted to: ADAM&REBECCA LEONARDO
For property located at: 12 HALL RD. EXT
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: ADAM&REBECCA LEONARDO
15 WESTON Dr Septic Alteration Residential
CLIFTON PARK,NY 12065-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
COUNTRY PLUMBER
518-222-3909
CLIFTON PARK NY 12065-0000
Plans&Specifications
2013-208
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,May 20,2014
(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 ofQuee bury MO y ay 20,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
i
1
Community Development Office Mk ! '' 2013
Town of Queensbury• 742 Bay Road • Queensbury, New York •12804
Office Use Only
TAX MAP NO. CQ PERMIT NO. PERMIT 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 VALID PERMIT.
OW NER: !✓7`7�/�7�1 G-Gx j/�6L INSTALLER: _] �-jc.�l-tTIZ-fLV(T�-� Lz
ADDRESS: ADDRESS:
PHONE NOS. PHONE NOS. / I
LOCATION OF INSTALLATION: f 2- 1,� T21- Z�Sc% C ✓1c�CSh�
RESIDENCE INFORMATION:
YEAR BUILT NO.OFX COMPUTATION = TOTAL DAILY FLOW
_BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 - INSTALLED?
r
1981_1991 X 130 SPA OR HOT T B
1992-present ^� X 110 A- INSTALLED? 1
PARCEL INFORMATION: j
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE !
✓ SOIL NATURE: SAND LOAM CLAY OTHER !
P
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCKIIMPERVIOUS MATERIAL: AT W T P ?
✓ DOMESTIC WATER SUPLY: MUNICIPAL L f well: voter supply from any septic system absorption is: ft) i
✓ PERCOLATION TEST: RATE IS P MIINUTE PER INCH(mpi) (Test to be completed by a licensed professional j
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: AN individual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless Install in a Planning Board approved subdivision).
TANK SIZE: GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool b.
SYSTEM TYPE: i
i
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type? i
HOLDING TANK SYSTEM Total required capacity? iM Tank size? Ab Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WOW MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. ��,c 1 l�S � f {sem cater ��lis:7�r�
fJC1L !.VCS- / 7
For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval I
granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or i
Circumstance known by or on behalf of an applicant,shall be void.
I have read the gut tions with respect to this application and agree to
abide b a I requirerrients of the Town of Q een ury QUESTIONS? CALL 761-8256 OR EMAIL
Sanit isposa >d nance. codes(&Queensburv.net
Vat/ey�'3VISIT OUR WEBSITE FOR MORE INFORMATION
on Responslbte www.Clueensbury.net
-�a e 1"3
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart:C �m/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: " 69
NAME: PUT NO.. —
LOCATION: / ;1 al INSPECT ON: cZ_f3
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam Clay
Type of Water: Municipal ell Water Q q
Waterline se ar ion distance ft. �— 3 `®
Well separ tion istance ft. L6
0th r wells: ft. +
Well Casing Le gth 0' +/ - Y N N/A P
150'to weP requirea if NO
Absorption eld: Total nth ft.
Len th of each tkencO ft.
Depth of tre h s ft.
Size of Sfdne
Seel eqe Pits: Nu er
Si e: x obi
Ston Si
Pi g Size Type
1
B Idling to nk
Tank to Di tributio Box
Distribution Bo to Fie Pit
0 nin led: _Y N
nd Ca _Y N
Inlet/Outlet P s Baffles Y N
Manholes 12"or les be w grade _Y N
[provide extension c lar if Yes Y N
Location/vSeparations
Foundation to tank ft.
Foundation to absorption
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 Rear Left Side Right Side Middle Front Middle Rear
System Use S us:
Approv
ial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\13uilding Codes Forms\Inspection Forms\Septic Inspection Report 03 2910.doc
-oVTj
N! OF QUEENSSURY
,& % : ,� T.
1 ,-e Topied Sy'
,w v*
MAP OF tAND5
OF
W: OULTrR 1,mccom,16 J, c- Date:
DATED:SEPTEMBER
ENpw,E l74ZV
"Act I
TOWN OF Qlj'r--E-IIPBURY LAKE TYU s60.1 15-19
T oe
rnaianc
,,I�tvtp, ey.., ',,A as
Based on 0
In $4 F
valli ouf commentsnf
pe plans al';: of OOOK 602 PA 058
OD'J�S�OF 224
Indicating � Ir BEGINNING 289
full rompllal
dance with �Ie 9-p
Newyork.stake- Rb CARTHET1
oRivE/--
a4z
vzl/
IRS AREA
25'1 ..
91112021t::(w.. .1 ,.
0. 0
0 STORY 0
R^3
RS LEGEND
IROO SET
V IRSOSTOP':"R,:,
0', 'RON PIPE POUNO
IRS STONEWALL
OF
Y THAT T"r.mW WAS PREPARED
=."y To THE Prox,
SEPTIC PLOT PLAN
114iS WAS TFA HEREON AZNCY
FOR*`OM TIKEE TOLE COMPO -
q=.,oz .0"wo"AL I HAVE SEEN OR OBSERVED L BJECT T10t,MAOr:CN THE CROUNO OCTOBER 19'2W9
C OR$UBSEOUENT O*"E"' NoTm DATED SEpTEWER B.2009,
SURVEY WAS MAOE FROM AN ACTUAL SO INSPEC
LEONAROO SUCH AS HOUS LLS, 1)THIS CERTIFICA76 OF 71TLE
CERTIFIED TO.AO1W 4.LEOSOUCUr REafAND/OM
/OR AMG�* JRVEY WAS PREPARD WTrH T,,SWEFIT OF
NOT 8#NK TT-S CS,.-AND SHOWN T DOC Ly 2)THIS SE INO TITLE NUI'SER MT("'54' CODE IF""CC FOR LANOSURVIFT'S
TITLE MEA DISTANCE T tSSUEo BEAR ANCE WITH THE 80S17II6
THIS SURVEY WAS pF&pAREDINACCOPO
AOOFTEDay THC NYS ASSOCIATION OF p.,ZOF=jCNAL LAND SURVVOnS' at, cto Or
ccRTiFIED By'----j;ZTT-8-EW--C-`S�TM5,LLS"YS 50131' G E DATE state 1•=aa
DATED'OrTooeR 20,20W Kap Or . survey made rcr S-1
g
SH
WICPI
D�u s en cca Le onardO Ci,52$
j. & Rebs Adam 3- REFERENCES anaroo
Ste-ves
-c- C.unty. N_ York
Town. at QucensburY, W4
12804
169 jiviiand Road QUeonsbury. NOW York