2014-280 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20140280 Application Number: A20140280
Tax Map No: 523400-295-014-0001-045-000-0000
Permission is hereby granted to: RAYMOND & ANNE HESS
For property located at: 16 QUEEN DIANA 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: RAYMOND &ANNE HESS Septic Alteration Residential
16 QUEEN DIANA Ln
Total value
QUEENSBURY,NY 12804
Contractor or Builders Name /Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2014-280
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,July 02,2015
(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 To of Que sbu Wyyt u e i a July 02,2014
4 f .'fl:
SIGNED BY •f. for the Town of Queensbury.
Director of Building&Code Enforcement
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: P20140280 Date Issued: Thursday, July 17, 2014
This is to certify that work requested to be done as shown by Permit Number P20140280
has been completed.
Tax Map Number: 523400-295-014-0001-045-000-0000
Location: 16 QUEEN DIANA Ln
Owner: RAYMOND & ANNE HESS
Applicant: RAYMOND & ANNE HESS
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 (-394P - —
property owner of the responsibility for compliance with Site Plan, 4' �
Variance, or other issues and conditions as a result of approvals by the Director of Building& ode Et orcement
Planning Board or Zoning Board of Appeals.
Office Use Only
Town of Queensbury Building & Codes
Received: ......-
SEPTIC
�SEPTIC DISPOSAL PERMIT Tax Map ID: &q t ! 7 -1.--q-3
Permit No.: 141— ,?,w V'
A permit must be obtained before beginnio , 7 construction / t. t;
) f
Permit Fee: $
,
I L Approvals:
Applicant: en 9 0 .r1 /4 S-f Installer/Builder `J./9'11/`/ 119--0,e,-,e,- J7-4`1.,,«e--
Address: /6 " egfr•F,7 -�/ ),i-c'1- C4 ne Address sv • .fin I 2/y
61-a- :c/ �-ya//T /1--/ /2e,--
Phone:
Phone: `76/ 6c F Phone 7rz " 72 f--7
Owner: Location of Installation
Address:
Phone
Contact Person for Building&Code Compliance: ( 7 re;' bi.e--0;-.1 Day Phone:776--176o
U
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older x 150 = Garbage Grinder installed? 'r"U
1981 -1991 jk_3 x 130 = 3 Po Spa or Hot Tub Installed? /"°
1992-Present x 110 =
Parcel Information:
Topography )e Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay _Other
Groundwater At what depth? /i."/
Bedrock/Impervious Material At what depth? C'71`
Domestic Water Supply 11.,Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- I- 5 per minute per inch(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 1/67Z gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(with#2 stone) Total length 2 d 0 ft. Each trench ,-5-0 X (r
Seepage Pit(S)(with#3 stone) How many? /"fr Size?
Alternative System Bed or other type? /"/'
Holding Tank System Total required capacity? 1r/* Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan; The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. There will be no exceptions.
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 Sanitary
Sewage Disposal Ordinance.
t /4ry �jPrint Name: )r' f Date: / z- '/ /
Signature: Wiz' : Date: / ✓ 2" J ! Ll
Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256
RPS foperty Description Report Page 1 of 3
Queensbury
295.14-1-45 * 16 Queen Diana Ln
Parcel Information: J
Parcel Location Acres Property Class School District Ward
295.14-1- 16 Queen Diana 0 75 210 - 1 Family Queensbury WARD
45 Ln Res Un.fr.sd 3
Owner Information: J
Owner Owner Address P.O. Box Owner Address Line 3
Raymond Hess 16 Queen Diana Ln Queensbury NY 12804
Anne Hess 16 Queen Diana Ln Queensbury NY 12804
2014 Assessment Values: (Previous Assessments) J
Parcel Assessed Land Assessed Total Uniform Full Market
Value Value % Value
295.14-1- 26,200.00 156,500.00 82.00% 190,900.00
45
Images: J
I.,•
c y
Image Date: 5/7/2014
Sales Information: O
Site Information: iJ
III II fit IIIIii II It II II Ii
http://www.queensbury.net/parcelsearch/RPS_INFO2.ASP?printkey=295.14-1-45 7/2/2014
RPS Property Description Report rage : of 3
Site Nbhd Code Sewer Water Utilities Site Nbhd Nbhd Road Entryonin'
# Desire T e Ratin T e e Code
1 162- Private Comm/ Electric Typical Suburban Average Improved Inter MDR
OldSubdv,Rs,Rur public Inspec
L`_._ Land Information: U
Site # Land # Type Front Depth [Acres Sq Ft
1 1 01-Primary 195 168 0 0
_ f. Residential Building Information: ii ,
Site Bldg # Ext Wall Yr # # # 1/2 # #
# Style Stories Mat Built Kit. Baths Baths Bedrm Firepl
1 Colonial 2 Alum/vinyl 1987 1 2 1 3 1
rite Fuel Central Bsmt Overall Constr
Heat Type Type Air Type Cond Grade SFLA
Hot
1 wtr/stm Oil No Full Normal Average 1632
Commercial Building Information: O
Improvements Information: O
Site Struct Code Dim Dim SQ # Constr Overall Yr
# 1 2 FT — Grade Cond Built
RP2-Porch-
1 34 6 0 1 Average Normal 2001
coverd
1 LP3-Patio-concr 0 0 260 la Average Normal 1989
1 RG 1-Gar-1.0 att 0 0 484 10 Average Normal 1987
Special District Information: El
Special District Units Taxable
EM001-Emergency medical 0 156,500.00
FP007-Fire protection 0 156,500.00
LB001-Crandall library dst 0 156,500.00
WT013-Queensbury water 0 156,500.00
Exemption Information: El
I 11 II II II
http://www.queensbury.net/parcelsearch/RPS_INFO2.ASP?printkey=295.14-1-45 7/2/2014
RPS 'roperty Description Report Page 3 of 3
Exemption IlAmount lITerm Year IlOwn Pct
41854-STAR B 24600 0 0
Permit Information: O
Permit Number Permit Date Permit Use Cost Estimate
P20010442 06-27-01 Covered porch 6,300.00
The information in the ti RPS database is maintained by the Town
of Queensbury Assessors Office
The information provided on this website is for GENERAL REFERENCE PURPOSES ONLY and should not be relied upon in lieu of referring to officially
adopted Town Codes,Local Laws or other documents available in Town Hall.
http://www.queensbury.net/parcelsearch/RPS_INFO2.ASP?printkey=295.14-1-45 7/2/2014
Town of Queensbury Building & Code Enforcement 1 n c !,' 3 o
Office No. (518) 761-8256 Gci
Septic Inspection Report
Inspection request received:
Name: e SS Inspected on:
Location: )142 4) U eel\ N a Aca-: Arrive: w a.m.I p.m.
Permit No.: /j— gO Inspector's Initials: P
_Aek-14-7
�, Comments and/or diagram
Soil Type: a I L�m I Clay
Type of Water: me pal Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells:
Well Casing Length 50'+/- Y_N N/A
[150'to well required if NO]
Absorption Field: Total length 2 - ft.
Length of each trench ..SD ft.
Depth of trenches ''Z... ft.
Size of Stone ,V}'1._
Seepage Pits: Number
Size: 0
(..
Stone Size:
Piping Size Type
Building to tank _ ['-5C.\ lD, ty_4JJ
Tank to Distribution Box ike.l.
le.if 'S
Distribution Box to Field I Pit / `( �3:S PC_Rc
Opening Sealed: �'Yf N 6_
End Cap �/1 N
Inlet/Outlet Pipes&Baffles LL e.-401r---V-4Z45,.1--k-:.
Manholes 12"or less below grade Y_N p�
[provide extension collar if Yes] Y_N ti
Location/Separations
Foundation to tank ft. t f7
Foundation to absorption "y_t� r ft.
Separation of Pits
Conforms as per Plot Plan N
Engineer Report and As-Built _Y
ETU Maintenance Contract provided V N p,-
Location of S stem 5ittirL se :
irr
Front Left Side Right Side Middle Front Middle Rear
S stem Use Sta . :
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
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