2007-556 TOVN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20070556 Date Issued: Tuesday, September 04, 2007
This is to certify that work requested to be done as shown by Permit Number P20070556
has been completed.
Tax Map Number. 523400-296-010-0001-055-000-0000
Location: 51 WINCREST Dr
Owner.. MICHAEL & ANN WOODBURY
Applicant: MICHAEL & ANN WOODBURY
This structure maybe occupied as a:
Septic Alteration Residential
By Ogler 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,$c Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070556 Application Number. A20070556
Tax Map No: 523400-296-010-0001-055-000-0000
Permission is hereby granted to: MICHAEL&ANN WOODBURY
For property located at: 51 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: MICHAEL&ANN WOODBURY
51 WINCREST Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER SERVICE
Plans &Specifications
2007-556
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,August 28,2008
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbuzy before the expiration date.)
Dated at the Town of Queensbury-, Tuesday,August 28, 2007
SIGNED BY for the Town of Queensbury
erector of Buil ' g nforcement
I+ ..►..r.rr►------------------►.r.......►.......rrr.r..-----r-------- r...................
��r �/� j ���FF10E USE ONLY � r r'
((} r
TAX MAP NO. PERMIT N0. "' PERMIT FEE z5, 00
o APPROVALS: ZONING TOWN CLERK ;
01
:............ ►....r.r.....! it ..►.......r..:
APPLICATION.FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUB C TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. /,
OWNER: L am' �. c`7 D� 161{t INSTALLER: r
ADDRESS: `�/ W z' �� �Q f i! ' ADDRESS: Y
PHONE NOS. Z ? PHONE NOS. 7/6 — OR\5�0
LOCATION OF INSTALLATION: �crPol
t...................-........-.....-.........................0.1.16.9......................................................................................................................................................... RESIDENCE INFORMATION.
YEAR BUILT X COMPUTATION= _ TOTAL DAILY FLOW !
..........-........................... BEDROOMS
............. ,...........1........................,........... ..........................5...........• ......................................i GARBAGE GRINDER
1980 or older I X 150 gallon per bedroom i = i INSTALLED?
1981--1991 I X 130 gallon per bedroom ..t..-
......-.. .. .......... .._.}...................................-..,.1,...X...z.....................................................................,..a... .,,1..............................................................,....... SPA OR HOT TUB. .,
1992-present110 gallon per bedroom s = i INSTALLED?
.. .......................................I.................................................................................................,....................................,............I.,......................
,
PARCEL INFORMATION: /�
✓ TOPOGRAPHY: FLAT ROLLING v STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND__z 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 IS.
✓ PERCOLATION TEST: RATE IS /- !�r 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: ode GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: -7 C'`D FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
1
✓ SIZE OF STONE TO BE USED: # Z /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./7'07AL CAPACITY. GAL.
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN li
1, 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.
1 have read the regulations with respect to this application and
agree to abide by these an 11 requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Wnature
Sanitary Sewa Disposal Ordinance.
codes�aueersburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.auee-nabury.net
Person ponsible Date 1 "
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
12
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ion
Queensbury Building&Code Enforcement Arrive: part:
742 Bay Rd., Queensbury, NY 12804 Inspecto s Initial :
MIT NO
NAME:
.:
LOCATION: SPECT ON: -y
RECHECK:
Comments and/or diagram
Soil T San Loam Clay
Type of Water: Munid I/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft,
Depth of trenches ft,
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
P!Rlng Size Type
-Building to tank
Tank to Distribution Box
Distribution Box to Field Pit � 0 QED
Sea OCLWJ Partial
and Ca
In Outlet Pipes&Baffles Y N
Location Se rations
Foundation to tank
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 Right Side
Middle F t e Rear
m s:
Approved
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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