2008-334 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4z Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080334 Date Issued: Friday, June 27, 2008
This is to certify that work requested to be done as shown by Permit Number P20080334
has been completed.
Tax Map Number. 523400-301-012-0001-031-000-0000
Location: 48 HELEN Dr
Owner. ALLEN & THERESA POWERS
Applicant: ALLEN & THERESA POWERS
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Bowl
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, vY
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 QUE ENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080334 Application Number. A20080334
Tax Map No: 523400-3 01-012-0001-03 1-000-0000
Permission is hereby granted to: ALLEN &THERESA POWERS
For property located at: 48 HELEN 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 Value
Owner Address: ALLEN &THERESA POWERS
Septic Alteration Residential
48 HELEN Dr
QUEENSBURY, NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-334
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,June 25, 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� Quee ul ; Ou"day,June 25,2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
_ '_ i OFFICE USE ONLY ' 0
1fro
+ TAX MAP NO. PERMIT NO. 1 PERMIT FEE I
APPROVALS: ZONING TOWN CLERK E ;
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUS BE 7 INED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. --�
OWNER: INSTALLER. //`
ADDRESS: r ADDRESS: 60 L-L'[' di�rc mot,
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMP
UTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom = C419SPA 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.)
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is C per minute per inch.
(Test to be dompleted 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).
�yi r "TANK SIZE: S ' ALLON (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? �d ft. Each trench G(� 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
Queensb nitary Sewage Disposal Ordinance. codes@ciueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.gueensbury.net
k9ndiure of Person Responsible Date
T�} Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
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Septic Inspection R ort
Office No. (518) 761-8256 Date Inspection r rec i d:
Queensbury Building &Code Enforcement Arrive: ✓part: a m
742 Bay Rd., Queensbu NY 12804 Inspector's Initia s:
NAME: U PER NO.:
LOCATION: INS E ON:
RECHECK:
Comments and/or diagram
Soil T / Clay
Type of Wate unici ell Water
Waterline se ration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length 2, C7 ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone x
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 N
Inlet/Outlet Pipes &Baffles N
Location Separations
Foundation to tank ft.
Foundation to absorption 21e ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Locat4ofteon Pro erty:
ar L e fight S' Middle Front Middle Rear
S s e
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
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"I have seen or observed, or believe 1 saw evidence of,
all obje,,Is such as houses, wells, trees, fences, etc.,
shown on tl'' document. 1 also represent that I have
rS ,I I a IrA sured the distances set forth on
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