2008-604 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(zt Community Development- Building &Codes (518) 761-8256
CERTIFICATE (3]VE7 COMPLIANCE
Permit Number. P20080604 Date Issued: Thursday, November 13, 2008
This is to certify that work requested to be done as shown by Permit Number P20080604
has been completed.
Tax Map Number. 523400-308-008-0002-056-000-0000
Location: 23 HOWARD St
Owner. DIANE CARPENTER
Applicant: DIANE CARPENTER
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& de E orcement
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: P20080604 Application Number. A20080604
Tax Map No: 523400-308-008-0002-056-000-0000
Percussion is hereby granted to: DIANE CARPENTER
For property located at: 23 HOWARD St
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. Tyne of Construction Value
Owner Address: DIANE CARPENTER Septic Alteration Residential
WAYNE MECHANICK Total value
16 COLUMBIA Ave
QUEENSBURY, NY 12804
Contractor or Builders Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-604
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,November 13,2009
(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 T r�7vlyw
November 13, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
--_f-----_- _--._-- OFFICE USE ONLY ------- ;---------------------
,
" TAX MAP NO. PERMIT NO. +
PERMIT FEE +
APPROVALS: ZONING +
TOWN CLERK + + +
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:
INSTALLER:
ADDRESS:. ADDRESS:
PHONE NOS. PHONE NOS. 5- 79
LOCATION OF INSTALLATION: f (JJ9ir'� Sf.
YEAR BUILT NO.OF X COMPUTATION= RESIDENCE INFORMATION:
BEDRO MS = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = I' GARBAGE GRINDER
(/C� INSTALLED?
1981 -1991 X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA OR HOT TUB
INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling ✓ y Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal y 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: 1U6 () GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
C6�7ST/NCeach garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total length dQ ft. Each trench X 15-14
❑ 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 761-8266 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes @aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensbury.net
ignature of Person Responsible 6ate
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Septic Inspection Repoli
Office No. (518) 761-8256 Date Ins ouest rec ived:
Queensbury Building &Code Enforcement Arrive: Mm/ L epart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: C- C- ' PERMIT NO.:
LOCATION: Z3 /'}-- i INSPECT ON: t 2
RECHECK:
Comments and/or diagram
Soil T Loam/ Clay
Type of Water: u i Well Water
Wate ine separa ion distance ft.
II sepa tion 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
Building to tank
Tank to Distribution Boxy,
Distribution Box to Field Pit h it
Opening Sealed: N
End Cap 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 4 perty:
Front Rear eft Side Right Side Middle Front Middle Rear
System Use Status:
pproved
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 Report.doc