2006-207TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060207
Tax i'dap No:
Application Number: A20060207
523400-301-014-0001-002-000-0000
Permission is hereby granted to:
GEORGE & ELAINE CASSANT
For property located at: 75 LAMBERT 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. Type of Construction
Owner Address:
GEORGE & ELAINE CASSANT
75 LAMBERT Dr
QUEENSBURY, NY 12804
c ;ontractor or Builder's Name / Address
ACTION SEPTIC/CHET SANDERS
Plans & Specifications
Septic Alteration Residential
Total Value
Electrical Inspection Agency
Value
2006-207
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Tuesday, April 17, 2007
(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 Towr nsb4
SIGNED BY
it 17, 2006
Director of Building & Code Enforcement
for the Town of Queensbury.
TOWN OF QUEENSBURY
LE,7 ily
742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20060207 Date Issued: Tuesday, April 18, 2006
This is to certify that work requested to be done as shown by Permit Number P20060207
has been completed.
Tax Map Number: 523400-301-014-0001-002-000-0000
Location: 75 LAMBERT Dr
Owner: GEORGE & ELAINE CASSANT
Applicant: GEORGE & ELAINE CASSANT
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 (.....""3
/�
property owner of the responsibility for compliance with Site Plan, /�
Variance, issues
or other and conditions as a result of approvals by the Director of Building & Code Enforcement
Planning Board or Zoning Board of Appeals.
Application for Permit — Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
I. OWNER INFORMATION:
Location of installation: %,S'/
Tax Map No. /
Owner's Namo:
Address: 2 5 44,
2. INSTALLER'S NAME :
Filo Permit No.
Foe Paid
Office Use
OC - o7
GO
) ,oz -2. j /6, t 4e't ,t - PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 11 bedroom(.) and multiply !I of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Yoar of House: No. of Bedrooms x Computation = Total Daily Flow
r
1991 — present
Garbage Grinder Installed
Spa or Whirlpool Installed
x 150 gaI/bdrm
x 130 gal/bdrm = ,'Q
x
110 gaI/bdrm =
yes ` / no w
yes / no
3oi. iy
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
1 I •.
caulur__ �viLI�atsrco____ Ci round Wntvr_.
. rni at what dr/rth
loans feet
Rolling
Steep slope
_%slope
clay
other
depth:
_D_QI►.ock..or_>!!r►GrolYlo.u.S_hn.t011.4 L_.. _Don►pslic_W:►ter'.Supply
at what depth
feet well
if well; water supply
from any septic -system
absorption is f .
other
Percolation Test: (To be completed by licensed art fe,s.slonal engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Conetructlon: All individual sewage disposal systems must be designed by n licensed
professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 2.50 gallons to the sin
of the septic tank and leach field for each Garbage (hinder, Spa or Whirlpool Tub
iti Septic Tank: ' gallon (min. size 1,000 gal.)
...y} ,: each trench 32. f. Total System Length: /9 2 fl• 2006
APR 17
Seepage Pit(s): number of size ()leach: fl. by fl.
Size of Stone to bo used: 11 / depth or thickness .___..._._._......__Ji'l't
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each; gallons / TOTAL Capacity; gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please read)
For your protection, please noto that pursuant to Suction 136-29 of tho Codo of lit° Town
of Quoonsbury, any permit or approval granted which is based upon or k 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 bo void.
I have rend the regulations with respect to this application and agree to abide by those and all
requirements of tho Town of Qucensbt Sanitary Sewage Disposal Ordinance.
Signature of responsible person Dat
Septic Inspection Report
Office No. (518) 761-8256
Queensbury Building & Code Enforcement
742 Bay Rd., Queensbury, NY 12804
NAME:
LOCATION:
RECHECK:
Date Inspection request received:
Arrive: am/pm Depart:Z\ am/pm
Inspector's Initials:
Pni)
Soil Type / loeam., Clay
Size
Type
Type of Water un cp/ Well Water
Foundation to absorption
2.C> ft.
Waterline separation distance
6k` `4-
ft.
;
Well separation distance " �"
Other wells:
ft.
Opening Sealed: N artial
ft.
Absorption Field: Total length
End Cap
1 'l Z,
ft.
Length of each trench
'';--2..
ft.
Depth of trenches
2..4
ft.
Size of Stone
K3(
Seepage Pits: Number
If4-
Size:
x
Stone Size:
Piping
Size
Type
Building to tank
Foundation to absorption
2.C> ft.
Tank to Distribution Box
6k` `4-
40
Distribution Box to ield / Pit
Engineer Report and As -Built
Y N
Opening Sealed: N artial
End Cap
Ince Pipes & Baffles
N
Location / Separations
Foundation to tank
10 ft.
Foundation to absorption
2.C> 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 fir/ Left Side Right Side
Middle Front
System Use S
Approved
Partial Approved and needs to be re -inspected, please call the Building & Codes Office
Disapproved
Middle Rear
PERMIT NO.:
INSPECT ON:
c:2o0(p-aQ7
Comments and/or diagram
Last revised 021006
Last revised 1/6/05
APR 1 7 2006
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that 1 have
personail measur d the distances set forth on the diagram."
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APR 1 7 2006
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7P1-
"1 have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have
personal' measur.d the distances set forth on the diagram."
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