2007-596 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. P20070596 Date Issued: Friday, September 28, 2007
This is to certify that work requested to be done as shown by Permit Number P20070596
has been completed.
Tax Map Number. 523400-301-006-0002-038-000-0000
Location: 10 SWEETBRIAR Ln
Owner. CHARLES & DEBORAH ACKLEY
Applicant: CHARLES & DEBORAH ACKLEY
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: P20070596 Application Number. A20070596
Tax Map No: 523400-301-006-0002-038-000-0000
Permission is hereby granted to: CHARLES & DEBORAH ACKLEY
For property located at: 10 SWEETBRIAR 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 QueensburyZoning
Ordinance. Tyne of Construction Value
Owner Address: CHARLES &DEBORAH ACKLEY
Septic Alteration Residential
10 SWEETBRIAR Ln
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2007-596
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, September 25, 2008
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To Queens ry; a ay, September 25,2007
SIGNED BY ,,/' for the Town of Queensbury.
Director of Building Code nforcement
OFFICE USE ONLYI
ZV7
TAX MAP NO. PERMIT NO. PERMIT FEE ii 24
o APPROVALS. ZONING TOWN CLERKvilf __ U l
CODES
______________________________ __._g�!IL'D��& I�i��$L
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFOTSS?ANCE OF A VALID
PERMITOWNER: � L( L � INSTALLER:
ADDRESS: ' 2 Si e e .L� r>�L C�� ADDRESS:
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION:f[b bn:�
............................................................................................................: .............................................._...................................; .................................................................... RESIDENCE INFORMATION.
NO.OF
YEAR BUILT I X COMPUTATION= TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
i 1980 or older : X 's 150 gallon per bedroom i = INSTALLED? W'Q
..........._..__ _....._..;...............................................
................................................._........................................... ........................................................
1981 -1991 X 130 gallon per bedroom = �fa
T TUB
....
................................................;........... ..............................<...........;....................................................................................i.......... ................................................. INSTALLED
1992-present I X 110 gallon per bedroom =
� A R ? N O
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 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: J(Do Z? GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: 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 �/S y car -
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
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 761-82.net
OR EMAIL
ensbury Sanitary Sew isposal Ordinance. coaes�aueensbury
// VISIT OUR WEBSITE FOR MORE INFORMATION
7 www.clueensbury.net
._ S' nature of Person RAdponsible Date /
Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury,NY 12804
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., Queensbury, NY 12804 Inspector's Initials: -p✓_ /
NAME: PERMIT NO.: (�
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil T n m/Cla
Type of Water: t4ftdW/ Well Water
Waterline separation distance I I ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft. �
DepLh of trenches 'Z. ft.
Size of Stone
Seepm Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N Partial
End Ca
Inlet/Outlet Pipes&Baffles N
Location Se rations
Foundation to tank 82 ft.
Foundation to absorption it. ft.
Separation of Pits N1ft.
Conforms as per Plot Plan Y
Engineer Report and As-Built y2W
Location o5Sbstem on Property:
Fear Left Side Right Side
Middle Front Middle Rear
st m use.
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
TOWN OF QUEENS3URY WI DUG-1 DEPARTMENT
Based on our limited examination,
compliance with our comments shall
not be construed as indicating the
plans and specifications are in full
compliance with the Building Codes of .-
New York State.
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