2008-239 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: P20080239 Date Issued: Friday, May 23, 2008
This is to certify that work requested to be done as shown by Permit Number P20080239
has been completed.
Tax Map Number: 523400-309-005-0001-020-000-0000
Location: 7 WINTERGREEN Rd
Owner: ROBERT & KAREN TUCKER JR
Applicant: ROBERT &KAREN TUCKER JR
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: P20080239 Application Number: A20080239
Tax Map No: 523400-309-005-0001-020-000-0000
Permission is hereby granted to: ROBERT & KAREN TUCKER JR
For property located at: 7 WINTERGREEN Rd
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: ROBERT & KAREN TUCKER JR
Septic Alteration Residential
7 WINTERGREEN Rd
QUEENSBURY, NY 12804-0000 Total Value
Contractor or Builder's Name / Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY, NY 12804
Plans&Specifications
2008-239
Septic Alteration - residential
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, May 22, 2009
(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 Town of ueens ury; T urs , ay 22, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code nforc ent
OFFICE USE ONLY r I^� �� ^11 f`'=
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TAX MAP NO. PERMIT NO. PERMIT
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PE1T: "
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
OWNER: p 6-
C I INSTALLER:
ADDRESS: G C '�-/ ADDRESS: CO L.cnf
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION:
NO.OF RESIDENCE INFORMATION:
BEDROOMS
YEAR BUILT 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 1 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand___ Loam Clay Other
✓ GROUNDWATER: At what depth?&� -
✓ 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: 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: N� ( � /& /�
1
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total lengt - I-® 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.
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
Queensbury Sanita Sewage Disposal Ordinance, codes�aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburV.net
C
Signature of Person Responsible Date
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury,NY 12804
B 5-LGL 6106
Se lc Inspection Report
Office No. (518) 761-8256 Date Insiv
Queensbury Building&Code Enfonrement Arrive: i t: 1i
742 Bay Rd., Queen ry, NY 12804 InspectoNAME:LOCATION: tv`
RECHECK:
Comments and/or diagram
Soil T • Sand a
T of ate • unid / Well Water
Waterline se lion nce ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total len th ft,
-Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size- Type
Building W tank
Tank to Distribution Box
Distribution Box toF*101 Pit
Opening Seated Partial
L.End Ca
Ins Outset Pipes&Baffles Y N
Location rations
Foundation to tank �� -
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 Prope :
Fron Re Side gh>`Side
Middle Front Middle Rear
m
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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