2008-338 TOWN OF QUIEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4z Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080338 Date Issued: Thursday, July 03, 2008
This is to certify that work requested to be done as shown by Permit Number P20080338
has been completed.
Tax Map Number. 523400-308-015-0001-011-000-0000
Location: 74 VAN DUSEN Rd
Owner. WILLIAM P. BROWN
Applicant: WILLIAM P. BROWN
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 /jA-
Variance,property owner of the responsibility for compliance with Site Plan,
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,Queembury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080338 Application Number. A20080338
Tax Map No: 523400-3 08-015-0001-011-000-0000
Permission is hereby granted to: WILLIAM P. BROWN
For property located at: 74 VAN DUSEN 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: WILLIAM P. BROWN
39 FRONT St Septic Alteration Residential
LAKE GEORGE,NY 12845-0000 Total value
Contractor or Builders Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-338
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,June 26, 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 th own Que b I') ursday,June 26,2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
rA OFFICE USE ONLY'------._______ _.______ %____. ____ '____________
01 ,
10 TAX MAP NO. PERMIT,NO.C '� >J PERMIT FEE Y ; ;
1
0 APPROVALS: ZONING TOWN CLERK ;
---------_-------------------------_---------------------_____: 00___------------------
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUB7, , -
REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.r, l
/, e-,L--
OWNER:W l l�J''� �Z7C1-1�J INSTALLER: 4-
ADDR `F-' 4 . Ifl� ` G ADDRESS:
PHONE NOS.`r y PHONE NOS. 7 � "/
LOCATION OF INSTALLATION L/ Vw:'-J- l U f:w
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom J 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 wh epth?
✓ 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: ` TIC)0 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 length t4V 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
bury San' Sewage Disposal Ordinance. codes@ciueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
!_(2-157/c-
www.gueensbury.net
JS4na�tu4re of Person Responsible Date
kaTown of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
Septic Inspection Report
Office No. (518) 761-8256 Date Ins iodrt ce'
Queensbury Building &Code Enforcement Arrive: : pm
742 Bay Rd., Queensbury, NY 12804 Inspector'sIni
NAME: no 1'j PE IT NO.:
LOCATION: -7 Va.- 0 sell_ I PECT ON: -Z-
RECHECK:
Comments and/or diagram
Soil T am Clay
Type of Water: ell Water
Water 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
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank L4
Tank to Distribution Box
Distribution Box to Field / Pit L
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes &Baffles ' Y N
Location Separations
Foundation to tank ft.
Foundation to absorption
Separation of Pits ft.
Conforms as r Plot Plan Y_ N
Engineer Report and As-Built Y N
LLocation tem on Propent ear Left Side fight Side Middle Front Middle Rear
us:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Reportdoc
�- Community Development O, ice
Town of Queensbury • 742 Bay Rd.
Queensbury, New York •12804 PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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