2013-225 iA ` TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-82W
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130225 Date Issued: Wednesday, July 09, 2014
This is to certify that work requested to be done as shown by Permit Number P20130225
has been completed.
Tax Map Number: 523400-308-017-0001-023-000-0000
Location: 101 NORTHWEST Rd
Owner: LEONARD & MARY FOSBROOK
Applicant: LEONARD & MARY FOSBROOK
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
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.
0./k TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130225 Application Number: A20130225
Tax Map No: 523400-308-017-0001-023-000-0000
Permission is hereby granted to: LEONARD & MARY FOSBROOK
For property located at: 101 NORTHWEST Rd
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: LEONARD & MARY FOSBROOK Septic Alteration Residential
101 NORTHWEST Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
MORNING STAR SEPTIC
793-2290 744-8139
107 JEWELL Rd
GANSEVOORT NY 12831-0000
Plans&Specifications
2013-225
Res. Septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,May 24,2014
(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 o Queen uty; Wrid 24 2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
ip, j Community Development Office
�5 � 1
ya:4,-It ,,, Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only
TAX MAP NO. .3 0 g, 1 ("/-'a3 PERMIT NO. 13J�a S PERMIT FEE 1/
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.
OWNER: te�l//6-315-'-vzk INSTALLER: $f 0.. S.� ZAr-1-.
ADDRESS: /D/ /1'. A /if) ADDRESS: /v7`�� 't- l2✓� /1.0--,...4v-u-A.'"
PHONE NOS. `79' 2 6 2 LIZ PHONE NOS. 7P7`i- 9 D 9 5141 0/3 7
LOCATION OF INSTALLATION: 2.2,-.4...0--.
RESIDENCE
.L? JL—
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older 3 X 150 = INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present „,,,,,.,A, X 110 = 33
INSTALLED? ,/✓
PARCEL INFORMATIOc_____>......)
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE A %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL A (If well:water supply from any septic system absorption is: ft)
✓ 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: /00o.yQ 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:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length /, S ft. Each trench 3-.5”" X 3 2.2 626-u`'
❑ 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
Sanitary Sewa e3 Disp rdinance. codes(7a queensburv.net
!:-7` `iG .23 /3 VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Pers Responsible Date www.queensbury.net
NYS-Real Property System Subject Property Inventory Summary RPS030N04/L001
County of Warren For Current Year File 2013 Date:5/23/2013
Town of Queensbury Parcel ID:308.17-1-23 Sheet 1 of 1 _
SWIS Code-523400 Active
,-Parcel Information , Parcel Land Size File Maintenance Info
Curr Owner: Fosbrook, Leonard Acct#: Front: 0.00 Acres: 1.12 ' Created: 11/20/1984
I Location: 101 Northwest Rd School Cd: 523402 Queensbury Un.fr.: Depth: 0.00 Sq Ft: 0 Modified: 05/01/2013 03:03 PM
Queensbury, NY 12804 Roll Sect: 1 Taxable RS/S: By: Batch FM byteri
Grid Coordinates
I Prop Class: 210 1 Family Res 1 East: 697216 North: 1624215 Folder: ASSESSMENT
-Site Characteristics
Site No: 1 Nbhd Cd: 173 Newer B to A Site Desire: 2 Typical DC Entry Type: 1 Inter inspec Economic Obs: 0
Site Type: R Residential Sewer Type: 2 Private Nbhd Type: 2 Suburban Zoning Cd: MDR Mod Density Re Data Mailer: No
Prop Class: 210 1 Family Res Water Supply: 2 Private Nbhd Rating: 2 Average Last Phy lnsp: 05/01/2013
Route No: Utilities: 3 Electric Road Type: 3 Improved Reappraisal: 01/28/2011
Residential Building Information
BldgStyle: 06 Contemporary No. Bath: 3 Fuel Type: 2 Natural Gs Area in Sq.Ft.
tY P rY YP Grade Adjust: 0 1st Story: 1,004 Fin Bsmnt: 0
No.Stories: 2.0 No. Half: 0 Central Air: Yes Pct Good: 0
Ext Wall Mtrl: 01 Wood Bath Qual: 3 Normal Bsmt Type: 4 Full Func Obs: 0 2nd Story: 1,004 Unfin 1/2: 0
Addl Story: 0 Unfin 3/4: 0
Act Yr Blt: 1981 No. Bdrms: 3 Bsmt Gar Cap: 0
1/2 Story: 0 Unfin Rm: 0
Eff Yr Blt: No, Rooms: 6 Overall Cond: 3 Normal
Yr Remodel: 1985 No.Fireplcs: 1 Ext Cond: 3 Normal 3/4 Story: 0 Unfin Ovr Gar: 0
No.Kitchen: 1 Fireplc Type: Int Cond: 3 Normal Over Garage: 0 SFLA: 2,008
Kitchen Qual: 3 Normal Heat Type: 2 Hot air Constr Grade: B Good Fin Attic: 0 Fin Rec Rm: 502
Land Breakdowns
Land Soil Wtrfrt Depth Infl Infl InfI Intl Land Unit Dim
Type Front Depth Acres Sq Ft Rating Type Factor Pct Cd 1 Cd 2 Cd 3 Value Price Code
01 Primary 165.00 200.00 0.00 0 0 0 64300 389.697
04 Residual 0.00 0.00 0.36 0 0 0 2160 6000.000
Additional Improvements
Structure Measure SQFT Overall Act Eff Yr Pct Func Sry Unit Bld Bld
Code Code Dim1 Dim2 MISC Qty Grd Cond Yr Built Gd Obs Life RCN RCNLD No. No. Sec
RP1 Porch, Open SQFT/Mi! .00 .00 250.00 1.00 B Norm 1981 0 0 0 4178 3467 0 0
RG1 Garage, 1 Story Attached Dimension 22.00 24.00 .00 1.00 B Norm 1981 0 0 0 17757 14738 0 0
RP1 Porch, Open Dimension 4.00 9.00 .00 1.00 B Norm 1981 0 0 0 822 682 0 0
RP6 Porch, Upper Covered Dimension 4.00 12.00 .00 2.00 B Norm 1981 0 0 0 2364 1962 0 0
..,,rn of Queensbury Building & Code Enforcement MV O Ad ca-
Office No.1518)71-8256
Septic Inspection Report
Inspection request received:
Name: j"vS f U v K Inspected on: 7 `7
Location: / p / ,A O t ~{� L Rc ( Arrive: s a.m.I p.m.
Permit No.: / 3 _A A `) Inspector's Initials. _.A
Comments anilor diagram
Soil Type: Sand I Loam I Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+I- 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 I Pit \ka_ cL\
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 I Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits
Conforms as per Plot Plan
Engineer Report and As-Built Y N
ETU Maintenance Contract provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use St s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
6 PI3-3A-5
518-793-2290
Fax#518-793-2115
N-_ 375 E-mail: morningstarseptic@hotmail.com
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DTIC IIIIRVICIE
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..ORATION OF CONSTRUCTION
EpfiiG P OT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES,WELLS,TREES, FENCES, ETC
TOWN OF QUEE►. 4:U; SHOWN ON THIS GOCUMENT,I HAVE PERSONALLY
BUILDING & C D:S 4 E _ MEASURED THE DISTAN SET FORTH ON THIS DIAGRAM.
Reviewed By.,. / ,,, S NATURE
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DATE
Date: Ar l
JDO*
Town of Queensbury vs....
742 Bay Road /!
Queensbury, NY 12804 - _
(518) 761-8232 Town of(2.yecnsbury
I
_(Permit Applicant ,_Property Owner I
LEONARD & MARY FOSBROOK LEONARD & MARY FOSBROOK
101 NORTHWEST Rd 101 NORTHWEST Rd
QUEENSBURY, NY 12804 QUEENSBURY, NY 12804
Tax Map#: 308.17-1-23
The permit listed below expired on : 05/24/2014
Application#: Permit#: Permit Type: Last Inspection Date:
A20130225 P20130225 Septic Alteration Residential 05/29/2013
Please contact the Town of Queensbury Building and Codes Office at 761-8256, to renew your permit.
Also, please contact us to update any inspections that may be required as part of this permit.
If the project is complete, please call for a final inspection so we may close out the permit, otherwise
there is a $50.00 permit renewal fee. This can be mailed to the Town of Queensbury in the form of a
check or money order payable to the Town of Queensbury.
Sincerely,
Town of Queensbury Building and Codes Department
"Home of Natural Beauty... A Good Place to Live"
(05 -c- ' Jo1
Z
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection reque ived:
S/Z /j
Queensbury Building &Code Enforcement Arrive: rt: =16. am !m
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia s: i
NAME: 1-C--->Y,(-00 14-A RMIT NO.: / 3
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LOCATION: i U I 1.,R=1 I]uk ST (1-01A-4-- INSPECT ON: /7 (1// 3
RECHECK:
Comments and/or diagram
Soil Type: San
Type of Water: Municipal/
Waterline separation distance 1. ft.
Well separation distance Ht4 ICC) ft. -t- ec;
Other wells: il5ZD ft. - �5-
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length I(oc ft.
Length of each trench ,"*. ( ..1>:6"- ft.
Depth of trenches ('/z-Z, ft.
Size of Stone a—z_ F{-,oik (,QflvE _E,4, 6s�-cct\
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank fi5c..1!-a� --)
Tank to Distribution Box y`t 933C_ 4,pR---5_';
Distribution Box to Field/ Pit Li c\1C_ i C G'Z_ Fv_O Lz 69_ Eye 17� LCiE\
Opening Sealed: ✓1( N
End Cap .// N
Inlet/Outlet Pipes&Baffles 7Y
Manholes 12"or less below grade74..
1.41[provide extension collar if Yes] _ NA
S BUILT
Location/ Separations
Foundation to tank E ft.
Foundation to absorption ZD .
Separation of Pits ft.
Conforms as per P = ' ..• Y 1\j...-
1
Engineer Report an, As-Bu, Y ✓N -51:40....... -i — Agip
ETU Maintenanc- o •.ct _Y_ N
provided --- E5-1-INC'-,L_Z \\ 'V-1 00k._ Cti2-3.6\D Z_
Location of System on Prope • 3 •\-c7w 'CiP..-k\ __ 1,NA (- 70 �` `'J f
Front Rear eft Si!- •'••t Side Middle Front Middle Rear
System Use Status:
proved
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
518-793-2290
Fax#518-793-2115
E-mail: morningstarseptic@hotmail.com
www.morningstarseptic.corn
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