2008-274 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. P20080274 Date Issued: Thursday, September 30, 2010
This is to certify that work requested to be done as shown by Permit Number P20080274
has been completed.
Tax Map Number. 523400-295-019-0001-014-000-0000
Location: 200 AVIATION Rd
Owner. EMMA E LIPORACE
Applicant: DONALD EARNHARDT
This structure maybe 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: P20080274 Application Number. A20080274
Tax Map No: 523400-295-019-0001-014-000-0000
Permission is hereby granted to: DONALD EARNHARDT
For property located at: 200 AVIATION 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: DONALD EARNHARDT
29 RIVER St Septic Alteration Residential
FORT PLAIN, NY 13339-0000 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
2008-274
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,June 09, 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 thee e *, ay,June 09, 2008
SIGNED BY �� for the Town of Queensbury.
Director of Building&Code Enforcement
___________________- OFFICE USE ONLY- --_________________-
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TAX MAP NO. PERMIT NO. ERMIT FEE _ 0
APPROVALS: ZONING f Iry '% 1 � ;
TOWN CLERK
r_-_____________:________-__-____-_.___-----------------------------_� f '
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PEff
A ssESt
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
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OWNER: INSTALLER: L �1
ADDRESS: ADDRESS: ;L D r- [� Mom► f'�
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION:
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = Vj
G 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 Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? 71V1q__
✓ DOMESTIC WATER SUPLY: Municipal a __ (If well: Water supply from any septic
Well-
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:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total lengt 09aft. 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
=ignature
tary Sewage Disposal Ordinance. codes @Queensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Www.c]ueensbury.net
son Responsible Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6106
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive; am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: _
NAME: (` ,� OL��E✓ �1����PERMIT NO.: "/5
2��
LOCATION: , INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: 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
150'to well required if NO
Absorption Field: Total length ft.
Length of each trench
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x / V
Stone Size:
Piping Size Type
Y V "
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y N
End Cap Y N
In Outlet Pipes&Baffles Y N
Manholes 12"or less below grade Y N
[provide extension collar if Yes Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan 0& N
Engineer Report and As-Built Y N
ETU Maintenance Contract Y_N
provided
Location of System on Property:
Front Left Side Right Side Middle Front Middle Rear
5ystern Use S
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Buiiding Codes Fams\Inspecdon Forms\Septic Inspection Report_03 2910.doc
(F--11 44,01,-47 .
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ m Depart am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials�'�,A. — ,
NAME: rH �r PERMIT NO.: _
LOCATION: 200 INSPECT ON:
RECHECK:
Comments and/or diagram
Soil T e• d/ am/ClayC
T of Water: /Well Water �„
Waterline separation distance ft.
Well separation distance ft. �a�.
Other wells: TV U Ij 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:
Stone Size:
Piping Si e T
Building to tank Ofi"
Tank to Distribution Box A
Distribution Box to Field / Pit
Opening Sealed: Y N
End Ca N
Inlet/Outlet Pipes&Baffles Y N
Location/ Separations
Foundation to tank Ica ft.
Foundation to absor tion ft.
Separation of Pits ft.
Conforms as per Plot Plan _
Engineer Report and As-Built Y
Location of System on Property:
Front ear Left Side Right Side Middle Front Middle Rear
Sy5tgm Use t
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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