2009-504 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
+,E R.j'IFI1N"...X8-XTE 0.,Wu COMPLI-A-NkC".N.E"
Permit Number. P20090504 Date Issued: Friday, October 23, 2009
This is to certify that work requested to be done as shown by Permit Number P20090504
has been completed.
Tax Map Number. 523400-295-019-0003-022-000-0000
Location: 17 OWEN Ave
Owner, PAUL & RAMONA LEONARD
Applicant: PAUL &RAMONA LEONARD
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090504 Application Number. A20090504
Tax Map No: 523400-295-019-0003-022-000-0000
Permission is hereby granted to: PAUL&RAMONA LEONARD
For property located at: 17 O WEN Ave
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: PAUL&RAMONA LEONARD
17 OWEN Ave Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-504
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, October 16, 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 ay, October 16, 2009
SIGNED BY for the Town of Queensbury.
Director of Building&Co Enforcement
.__ OFFICE USE ONLY _________________________i I...................._'
o Z7,5-1 j 7--3 —Z2_01 ---- , ;
TAX MAP NO. PERMIT"NO. v j � ERMIT 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, r
OWNER: c/11 ^ (U INSTALLER:
ADDRESS: OW�n y -e ADDRESS: 2 Lowe,/ VWIf(gn5i 0 --f
PHONE NOS. ✓ PHONE NOS. + "
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= TOTAL DAILY FLOW
BEDROOMS I GARBAGE GRINDER
1980 or older 3 X 150 gallon per bedroom = Lt:;Q INSTALLED?
1981 -1991 X 13o gallon per bedroom — SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION: -TU r\
✓ TOPOGRAPHY: Flat rolling V Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth? N k
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?._
✓ DOMESTIC WATER SUPLY: Municipal Well (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 architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: 1213Q 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? N.
❑ HOLDING TANK SYSTEM Total required capacity? 1 v
Tank size? Number of tanks? 1�
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 misrenrAQan+�+:.... --
failure to make a material fact or circumstance known by nr mn M^1-19 -`
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm De art: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: PER NO.: 5-0
LOCATION: j - C� INSPECT 0 l
RECHECK:
Comments and/or diagram
Soil Type: a Loam/ Clay
Type of Water: unici a / Well 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 L-
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed:C Y N
End
Inlet/Outlet Pipes &Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Se ration of Pits ft.
Conforms as per Plot Plan _Y N
Engineer Report and As-Built Y N
Location of System o operty:
Front R ar Left Side Right Side Middle Front Middle Rear
S st a s:
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
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspecti5r�Mquest received:
Queensbury Building &Code Enforcement Arrive: �-�,,-5 am/T Depart: am/pm
742 Bay Rd., Queen ury, NY 12804 Inspector's Initials:
NAME: PERMIT NO.:
LOCATION: X1, INSPECT ON:
RECHECK: /
Comments and/or diagram
Soil T Sand Loam/ Clay
Type of Water: Municipal/ Well 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
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Ca iY N
Inlet/Outlet ipes&Baffles Y N
Location I Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Repqrt and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
A roved
artial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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coTrp,iance vith our comments shall
not by construed as indicating tW
- - - ifications are in full
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_ _- - - -- ---compliant;with the Build.ng Codes of
New Yo;k State.
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