2009-135 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090135 Application Number. A20090135
Tax Map No: 523400-227-017-0001-029-000-0000
Permission is hereby granted to: STEPHEN &CARYN LAFLECHE
For property located at: 12 WATERS EDGE Dr
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. Tyne of Construction Value
Owner Address: STEPHEN & CARYN LAFLECHE
12 BERKSHIRE Dr Septic Alteration Residential
CLIFTON PARK, NY 12065-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-135
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,April 20, 2010
(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 loJuw
t
e u � /� ,April 20, 2009
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(zt Community Development- Building &Codes (518) 761-8256
CERTIFICATE (31'r' COMPLIANCE
Permit Number. P20090135 Date Issued: Wednesday, March 24, 2010
This is to certify that work requested to be done as shown by Permit Number P20090135
has been completed.
Tax Map Number. 523400-227-017-0001-029-000-0000
Location: 12 WATERS EDGE Dr
Owner. STEPHEN & CARYN LAFLECHE
Applicant: STEPHEN & CARYN LAFLECHE
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.
G _ ^9FF--E USE ONLY
TAX PERMIT F
MAP N f `-- ____-, ,
PERMIT NO. 0 r
EE
o APPROVALS: ZONING ;
TOWN CLERK '
____ , / I
____ ! r____-_________________
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: Steve and Car n LaFleche
INSTALLER: Crandall Excavating
ADDRESS: 12 Berkshire Drive
Clifton Park, NY 12065 ADDRESS: 63 Woodchuck Hill Road
PHONE NOS, 877-8122 La a George,
NY
PHONE NOS. 793-0431
LOCATION OF INSTALLATION: 12 WateX-E-EA&_eRoad, NY
YEAR BUILT DR OF X COMPUTATION= RESIDENCE INFORMATION:
BEDROOMS = TOTAL DAILY FLOW
1980 or older 4 X 150 gallon per bedroom - GARBAGE GRINDER
1981 -1991 - 600 INSTALLED? No
X 130 gallon per bedroom -
1992-present. X 110 gallon per bedroom - SPA OR HOT TUB
- _ _
PARCEL INFORMATION: INSTALLED? No
✓ TOPOGRAPHY: Flat rolling x Steepslope- o
pe /oSlope
✓ SOIL NATURE: Sand
Loam x Clay Other
✓ GROUNDWATER: At what depth? 2'
BEDROCWIMPERVIOUS MATERIAL: At what depth? 4'
✓ DOMESTIC WATER SUPLY: Municipal Well
Lake George (If well: Water supply from any septic
system absorption is n)
✓ PERCOLATION TEST: Rate is N/A
per minute per inch.
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOAo68�j�TRU�TIONT All Individual sewage disposal systems must b
e designed by
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivisi
TANK SIZE. 1250 on).
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 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 TOW N
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 136-29 of the Code
of
permit or approval granted which is based upon or is granted in reliance upon any mown of Queensbury, any aterial failure to make a material fact or circumstance known by or on behalf of an applicant, shall be voldresentation or.
I have read the regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensb anitary Sewage Disposal Ordinance. codes�aueensbury nnr
VISIT OUR WESSITE FOR MORE INFORMATION
Ignature of Pe son Responsible Date 9 """'"•pUeensbun�net
y-Two JA,t ��
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It, 14 Town of Queensbury Community Development Office - 742 BayRoad,, Queensbury,NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Ins Win,request received:
Queensbury Building &Code Enforcement Arrive: 1/ am/ m Depart: am pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: LA PERMIT NO.: _ ' / 3�5
LOCATION: INSPECT ON: ?�
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam / Clay
Type of Water: Municipal Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + J - Y N _N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Pi in size. Type
Building to tank c�
Tank to Distribution Box ri <
Distribution Box to Field Pit
Opening Sealed: N
End Ca N
Inlet/Outlet Pipes &Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y_ N
Engineer Report and As-Built _Y_ N
Location of System on Property:
Front Re r Left Side Right Side Middle Front Middle RCar ;L:�
S t Use t
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-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc