2007-455 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. P20070455 Date Issued: Wednesday, August 25, 2010
This is to certify that work requested to be done as shown by Permit Number P20070455
has been completed.
Tax Map Number. 523400-308-012-0002-062-000-0000
Location: 36 STEPHANIE Ln
Owner.. KEITH HENDRY
Applicant: PATRICIA CRANS
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
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: P20070455 Application Number. A20070455
Tax Map No: 523400-308-012-0002-062-000-0000
Permission is hereby granted to: PATRICIA CRANS
For property located at: 36 STEPHANIE Ln
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. Tune of Construction Value
Owner Address: PATRICIA CRANS
36 STEPHANIE Ln Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans &Specifications
2007-455
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,July 23,2008
(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 To o eensb *oncjay,July 23, 2007
SIGNED BY for the Town of Qwensbury.
Director of Building&Code Enforcement
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FICE USE ONLY
TAX MAP NO. PERMIT NO. s/ PERMIT FEE
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APPROVALS: ZONING
I TOWN CLERK ' r '
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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: �C INSTALLER .
ADDRESS: � �.t n`{ � `� �� ,— /rl l b- ADDRESS:
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION:
.............................................................................................................;........................................ . ....................................
! I NO.OF { ................ ......................,........................................ RESIDENCE INFORMATION:
j YEAR BUILT I X i COMPUTATION= ; _ TOTAL DAILY FLOW
i BEDROOMS 3
t................................................;........................................ (...............................
.....................................................d...........;.......................................................................... GARBAGE GRINDER
1 1980 or older € X 150 gallon per bedroom !iI............................_._.........
; € INSTALLED?
1981 -1991 .
130 gallon bedroom
..................I.... .. ;.......................................................;....... . ................ .... ... .........................................................,...........
SPA OR HOT TUB
1992..present X i 110 gallon per bedroom _ 1 1 INSTALLED?
c.........................................................................................................................................
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 1S 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:� GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH aI FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY., GAL.
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:.:.:.:.:.:.:.:...:.:.:.:.,.,.;
E NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
r APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 1'
s:<...:..:...:..:...:...<.<..........................,....................<.,.:..,...:<......<.....................................................:.:<::...:,,................<....:....,..,..<....................................................................
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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
Queensbury Sanitary Sewage Disposal Ordinance. codes 0gueensbgrv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
211 /I 2 www.ciueensbury.net
Signature of Person Responsible ate ` L
5 Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Ins y request received:
Queensbury Building&Code Enforcement Arrive: am/ rt: am/Prr►
742 Bay Rd.,Queensbury, s
(�NY 12804 Ins i Initials:
NAME: `AW5 PERMIT'NO.: 01
LOCATION: 4( G � INSPECT ON:
RECHECK:
Comments andlor diagram
Soil Type: Sand Loam I Clay
Type of Water: Municipal Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total length ft.
Lenoth of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
.-Piping Size Type
Building to tank
T nk to Distributio x
istribution Box t6 f4eid Pit
Opening Sealed: Y I N Partial
End Ca
Inlet/Outlet Pipes&Baffles Y N
Location/Se rations
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 eft Side Right Side
Middle Fron Middle Rear
%gftm
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
Septic Inspection Report
Office No. (518) 761-8256 Date In nest received:
Queensbury Building&Code Enforcement Arrive: am/ rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Ins r'$ nitials:
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil T m'V Clay
Type of Water: Mu 'a 1/Well Water
Waterline se do nce ft.
Well separation distance ft,
Other wells: ft,
-Absorption Field: Total length 2--el V 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 Box t 4
Distribution Box to Fie Pit 4
Opening Sealed: Y artial
A"r
End Ca
Inlet/Outlet Pipes&Baffles Y N
Location Se rations
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft.
Conforms as r Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rea Left Side Right Side
Middle Front Middle Rear
System Use Status:
proved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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