2008-470 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CE R T I F I C AT E OF COMPLIANCE
Permit Number. P20080470 Date Issued: Friday, September 19, 2008
This is to certify that work requested to be done as shown by Permit Number P20080470
has been completed.
Tax Map Number. 523400-296-010-0001-032-000-0000
Location: 54 WINCREST Dr
Owner. WYLLA MAE BITNER TRUST
Applicant- WYLLA MAE BITNER TRUST
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 (" f
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: P20080470 Application Number. A20080470
Tax Map No: 523400-296-010-0001-032-000-0000
Permission is hereby granted to: WYLLA MAE BITNER TRUST
For property located at: 54 WINCREST 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: WYLLA MAE BITNER TRUST
4902 TURTLE CREEK Trl Septic Alteration Residential
OLDSMAR, FL 34677-0000 Total Value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2008-470
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,August 29, 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 QueegLsbury, Friday,August 29, 2008
SIGNED BA for the Town of Queensbury.
Director of Buil ' g&Co e Enforcement
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-" �'- r OFFICE USE PNLY ;
f TAX MAPr NO. PERMIT NO. 41 ERMIT FEEOk
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APPROVALS: ZONING
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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,
OWNER: �J INSTALLER:
ADDRESS: W/ti v v ADDRESS: f(w��/`
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION:
t................................... ........
.............................................. RESIDENCE INFORMATION.
s YEAR BUILT BEDROOMS X COMPUTATION= t = TOTAL DAILY FLOW
... ........i........... .......................................i GARBAGE GRINDER
................................................ . :.......,... .,... INSTALLED
.......................................... 1.......,......................,..................,....... I...............,,..................
}J 1980 or older I X ; 150 gallon per bedroom = i i
1.....�........................................t........................................... (...........q�................................................................�.....�...........i.......... ............�............. ?
1981 1991 (4 X ; 130 gallon per bedroom I = I SPA OR HOT TUB
I...........................»...................�..........................................................3..........,.............................................................,b..........�i...............,.�.. ...i
1992-present i X 1 110 gallon per bedroom ; INSTALLED
h..............................................i............;..........................,...,...,...............................
........;...........i..,...............................,................,......................
i
PARCEL INFORMATION:
✓ TOPOGRAPHY: FL OLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY - OTHER
✓ GR UNDWATE_ 1L!T 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 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 field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK: GALLOt (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENC46--FT.
✓ TOTAL SYSTEM LENGTH: _FT. SEEPAGE P.IT(S): HOW MANY?
✓ SIZE OF EACH_ FT, X FT.
✓ SIZE OF STONE TO BE USED: # �k*/DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: ��X ''
✓ ALTERNATIVE SYSTEM: ~ l �� LENGTH AND/OR SIZE -L& (.
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: A-111—/SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY. ---GAL,
......:.........................:.......................:.:.........................:.............:.................:.:.....:.:.:.:.....:.:...:.:..............:...........:.....:,.:.,.:...:.:.:.,,.,:, ,..:.,..:. :,.,................ .. , ,: .....................
E 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 QUESTIONS? CALL 761-8256 OR EMAIL
agree to abide by these and all requirements of the Town of codes aaueens urv.net
Queensbury nitary Sewage Disposal Ordinance.
7 VISIT OUR WEBSiTE FOR MORE INFORMATION
f/ www.aueen_ebury.net
Sig ure of Person Responsible Date
QTown of Queensbury - Community Development Office 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Ins j�Sn request received:
Queensbury Building &Code Enforcement Arrive: 'O.C am�pm 4epart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspe is Initials: J
�—,Vf—r) &NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
J Comments and/or diagram
Soil T Loam Clay
Type of Water:Xuni i Well Water
WateAWa.seligration 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 S' e Type
Building to tank
Tank to Distribution Box 2.D
Distribution Box to Field Pit
Opening Sealed: N
End Ca N
Inlet/Outlet Pipes&Baffles ' Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits
Conforms as per Plot Plan Y N 46e---
En ineer Report and As-Built Y N
Locatio ystem on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
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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