2009-606 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: P20090606 Date Issued: Wednesday, December 23, 2009
This is to certify that work requested to be done as shown by Permit Number P20090606
has been completed.
Tax Map Number: 523400-278-019-0001-007-000-0000
Location: 478 STATE ROUTE 149
Owner: FRANCIS & CAROLYN MARTINDALE
Applicant: FRANCIS & CAROLYN MARTINDALE
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
A
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: P20090606 Application Number. A20090606
Tax Map No: 523400-278-019-0001-007-000-0000
Permission is hereby granted to: FRANCIS & CAROLYN MARTINDALE
For property located at: 478 STATE ROUTE 149
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: FRANCIS & CAROLYN MARTINDY
478 STATE ROUTE 149 Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2009-606
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, December 17, 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 T Quee r,�y`�� ! h sd ,December 17, 2009
SIGNED BY " for the Town of Queensbury.
Director of Building&Code Enforcement
..............................,....,..,..,.,...,. ,.........,,,...
12 1 / OFFICE USE ONLY
0 0
TAX MAP NO. PERMIT NO. fZ6 IT % % %PERM FEE , 1 ,
APPROVALS: ZONING I Y 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: Ca A,' M A. �i N v`��{ INSTALLER: /
ADDRESS: � U / r ADDRESS: �(�l /r rr j Cz
PHONE NOS. PHONE NOS. '�4,Pt
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
BEDROOMS
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED?_.
1981-1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope . %Slope
✓ SOIL NATURE: Sand n Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth`
✓ DOMESTIC WATER SUPLY: Municipal Well (if well: Water supply f om any septic
system absorption is�ft.)
✓ PERCOLATION TEST: Rate is minutes,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: 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: -
O r
*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 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.
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TOWN OF UEEi SBURY
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Septic Inspection Report
Office No. (518) 761-8256 Date Ins coon eiv
Queensbury Building &Code Enforcement Arrive: °� p part: a pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initi
NAME: PE MIT NO.:
LOCATION: -�- j�`j I PECT ON: - 07
RECHECK:
Comments and/or diagram
Soil Type: Sand ""am / Clay
Type of Water: 'nici l Well Water
Waterline se aration 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 `r" n -
Tank to Distribution Box -
Distribution Box to Field Pit t4 v
Opening Sealed: Y N
End Ca _ N
Inle Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _ N
Engineer Report and As-Built_ Y_ N
Location of System on Property:
Front R ar efC"gide Right Side Middle Front Middle Rear
S stem Use S�tatir":
Sy
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-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
l0le Vfl,o6!� L
141 ,
Septic Inspection Report
Office No. (518) 761-8256 Date Ins coon retest r iv -�
Queensbury Building &Code Enforcement Arrive: ° ti art: =Z� am)im�
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials. -'-'
NAME: 1 PERMIT NO.:
o
LOCATION: /4-7 INSPECT ON:
RECHECK: V
�-w Comments and/or diagram
Soil T n oa Clay
Type of Water: Munici ater
Waterline separation distance ft.
Well separation distance
Other wells:
Well Casing Length 50' + - I Y N_N/A
Absorption Field: Total length ft.
y—
Len th of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number.
Size: x
Stone Size:
L Piping Size Type
Building to tank "
Tank to Distribution Box
Distribution Box to Field Pit �cX
-- -t -' Opening Sealed: Y N >;�y
End Cap N
Inle Outlet Pipes&Baffles 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 Rear Left Side , Right Side,) Middle Front Middle Rear
S m s 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-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc