2009-332 i
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Cedes (518) 761-8256
E Iv TIFI ATE (".)YUc C0MPL1-A--N- ke--'3r"
Permit Number. P20090332 Date Issued: Friday, July 24, 2009
This is to certify that work requested to be done as shown by Permit Number P20090332
has been completed.
Tax Map Number. 523400-309-014-0001-040-000-0000
Location: 10 SECOND St
Owner: AMY W GOODING
Applicant: AMY W GOODING
This structure maybe occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DUES 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.
TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090332 Application Number. A20090332
Tax Map No: 523400-309-014-0001-040-000-0000
Permission is hereby granted to: AMY W GOODING
For property located at: 10 SECOND St
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other infon-nation hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: AMY W GOODING
10 SECOND St Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-332
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,July 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 th of Que bury; / Monday,July 20,2009
SIGNED B for the Town of Queensbury.
Director of B & de Enforcement
.. 1E
OFFICE USE ONLY
�ERMIT
<TAX MAP NO. P RMIT NO. " /� FEE_2
n :; 2009r
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APPROVALS: ZONING TOWN CLERK r rr
r oTpWN OF Qi✓i"ENSBURY
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,
L�
OWNER: ` �J � /Al INSTALLER: •e,'
ADDRESS: 0 � ydJ S ADDRESS: ? 6
PHONE NOS. PHONE NOS. / / 90 C)O
LOCATION OF INSTALLATION: _10 ca- C.y,J D s,
NO.OF RESIDENCE INFORMATION:
BEDROOMS
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED? AID
1981 -1991 f X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED? f /•��/v -
PARCEL INFORMATION: TTT--
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sande Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal ell (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is 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 rchitect (unless installer: in a Planning Board approved subdivision).
TANK SIZE: GAL ON (IVfI 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:
0-ASSORPTION 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 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 Oueensbury, any
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r =ON:
Queensbury Building &Code Enforcement Arrive: a 742 Bay Rd., Queensbury, NY 12804 InspectoNAME: P MITLOCATION: NSPEC
RECHECK:
Comments and/or diagram
Soil T e: oam Clay
Type of Water: nici ell Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - 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:
Piping Size Type
Building to tank I` s3G
Tank to Distribution Box "
Distribution Box to Field Pit !;AmOpening Sealed: N
End Cap N
Inlet/Outlet Pipes&Baffles N
Location Separations
Foundation to tank ft.
Foundation to absor tion 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 Rear Left Side Right Side Middle Front Middle Rear_
System
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 U\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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"I have seen or elsservW,K bOw I sa}; evidence of,
all objects such as houses- ►ells,trees, fences, etc., -
lip shown on this document. I alpq represent that I have -
Ily m t noes set f1hrth on t diagram," -
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