2008-439 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERT I F I CAT E OF COM P L I AN CE
Permit Number. P20080439 Date Issued: Wednesday, September 03, 2008
This is to certify that work requested to be done as shown by Permit Number P20080439
has been completed.
Tax Map Number. 523400-302-005-0001-008-000-0000
Location: 4 SCHOOLHOUSE Rd
Owner. HARRIET PATTERSON
Applicant: HARRIET PATTERSON
This structure may be occupied as a:
Septic Alteration Residential
By Oder 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,Qwensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080439 Application Number. A20080439
Tax Map No: 523400-302-005-0001-008-000-0000
Permission is hereby granted to: HARRIET PATTERSON
For property located at: 4 SCHOOLHOUSE 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: HARRIET PATTERSON
4 SCHOOLHOUSE Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-439
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, August 20,2009
(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 f Que blu day,August 20, 2008
SIGNED BY �' V for the Town of Queensbury.
Director of Building&Code Enforcement
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OFFICE USE ONLY
TAX MAP NO. PERMIT NO. PERMIT FEE i
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APPROVALS: ZONING TOWN CLERK_
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APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. �9 J
OWNER: / j* INSTALLER:
ADDRESS: TJ(�!J L, G�� / _ ADDRESS: SC 400
PHONE NOS. PHONE NOS,
LOCATION OF INSTALLATION: T ,£` /`Lll� [
........................................................................................ RESIDENCE INFORMATION.
YEAR BUILT ': X COMPUTATION= _ ' TOTAL DAILY FLOW
{ NO.OF
,BEDROOMS i ': GARBAGE GRINDER
.............,........,..,..............,............................,..............................;
1980 or older ; X 150 gallon per bedroom = I
INSTALLED
:............................................«.......................................,...........,....,.......................... ...........1.....,.............,.,..,.,,..,...........................................
1981 -1991 { X 130 gallon per bedroom
SPA OR HO 7
UB
1................................................1.,.............,........,....................,........,a...........................,,.,.................,..................,..;........,..i.....,..,,.,..,...,...,..,.................................,...........,.,; T
I 1992-present X 110 gallon per bedroom j = i INSTALLED?
I..........................................................................................................,..........................................................................;........,..;..,...........................................
,...............,......,....i
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING)( STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROMIMPERVIOUS 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 MIINUTE 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). Add 250
gallons to the size of the septic tank and leach fi!d for e c garbage grinder, spa or whirlpool tub. C
✓ SEPTIC TANK: /0 Q 1) GALLON (MIN. SIZE IS 1,00AAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X N FT.
✓ SIZE OF STONE TO BE USED: # _/DEPTH OR THICKNESS_L!FT.
✓ BED SYSTEM SIZE: X J61A
✓ ALTERNATIVE SYSTEM: LENGTH ANDIOR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: .,A1 7 /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL. YJ 0
1; NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
j 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 QUESTIONS? CALL 761-8256 OR EMAIL
agree to abide by these and all requirements of the Town of codes 0 ageensbury.net
Queensbury Sanitary Sewage Disposal Ordinance.
VISIT OUR WEBS{TE FOR MORE INFORMATION
www.aueensbury.net
Sjgda-ture of Person Responsible Date
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
r
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm 3 rt: m/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ?y 1�
NAME: ` � -�a PER IT NO.:
LOCATION: INSPECT ON:
RECHECK: (z� (
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
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
V
Buildin to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y N (,
End Ca _Y N
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank ft.
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 Property:
Front Rear Left Side Cight Side Middle Front Middle Rear
S t :
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-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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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., Qu�bu NY 12804 Inspector's Initials:
NAME: fit^, PERMI�N :
J✓
LOCATION: fi INSPECT ON:
RECHECK:
Comments and/or diagram
Soil T Loam/ Clay
Type of Water Mu ' ' I Well Water
Waterline separation 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 ft.
Depth of trenches `' ft.
Size of Stone
See a Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tankL
Tank to Distribution Box Z
Distribution Box to Field Pit t Z 2'i Opening Sealed: Y N
End Ca Y
Inlet/Outlet Pipes&Baffles Y
Location Separations
Foundation to tank ft.
Foundation to absorption ft. w/
Separation of Pits Y ((((
Conforms as per Plot Plan y .2% ji �1:"i (
Engineer Report and As-Built Y N
Location of System on Property:
•• 45 --
Front Rear Left Side SRightSi Middle Front Middle Rear
System Use Status:
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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