2007-697 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20070697 Date Issued: Wednesday, January 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20070697
has been completed.
Tax Map Number. 523400-301-012-0003-028-000-0000
Location: 30 PROSPECT Dr
Owner. BARBARA SCHIERLOH
Applicant: BARBARA SCHIERLOH
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&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: P20070697 Application Number. A20070697
Tax Map No: 523400-301-012-0003-028-000-0000
Permission is hereby granted to: BARBARA SCHIERLOH
For property located at: 30 PROSPECT 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: BARBARA SCHIERLOH
30 PROSPECT Dr Septic Alteration Residential
QUEENSBURY,N.Y. 12804 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2007-697
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,November 14,2008
(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 own Que br� nilday,November 14,2007
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
........................... ........................................ _ ..........
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. f _0 RMIT FEE f ;
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. J
OWNER: �'f� z / rZ '( INSTALLER: w
is
ADDRESS: ADDRESS:
PHONE NOS. PHONE NOS._
LOCATION OF INSTALLATION:
........:................................................................. .............
......... .................... .. ...................................................................;...........}.......................................................... RESIDENCE INFORMATION:
YEAR BUILT NO. X i COMPUTATION= _ TOTAL DAILY FLOW
;......BEDROOMS ...........a...........................................I........................................i..........................................................................; GARBAGE GRINDE
1980 or older Z X 150 gallon per bedroom
:...........1...9...8.._i......1..9....9...1............:'s.................................................X.............1...3...0.....g...a...l.l.o....n....p...e....r...b.,...., INSTALLED?
300
a
. ......... =....i...................... . .........................................
e d.r.o...o.m. ••. ! i SPA OR HOT TUB„/
i...................................•............P..............................................E...........4.........................................................................0...........4..................................................
.........«.............� INSTALLED?, /Y
1992 present X 110 gallon per bedroom = ; I
.............................................................................................;............,.......................................................................................................................................................,........;
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE:SAND X LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCKAMPERVIOUS 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- C5-��O GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH 6 FT. XrFT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS 2- 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.
I....•.•...•.•;•;•.•;•.........M.......•.....•...•;•1•.•;•i•..:.:•I.•:•.•;.:•.......• ...:.........
;•..i•:..:.:.:.:.:•:..:.:.:.:•:•:.:•...i•:..•:•: :.i.:.i.:.....:•.•:..•:.:.:•i.i.:v.:...:.:.:.i.i•:•;•i4•.:..i•:.;.:•y.;•;•;•..•.;•:•:•i•y;•.•..•.•..:•......i...Y✓:..•....:•......:•...•....:.✓......:.:.........:.:.v:.:•Y:.:...Y;•;...4
i i;
v. NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
i:..:.....:.......:.................:.....:.:...:...:...:...:.:...:...........:.........................:.:.:...........:...,.:.,.:.:...:.....:...:.:.....,.......:.,.........................
..:.....:.......:.:.....i.........:.:...... .:............. .............. .......
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@aueensburv.net
Queensbury Sanitary Sewage Disposal Ordinance.
VISIT OUR WEBSITE FOR MORE INFORMATION
ti www.aueensburv.net
// /`/-`
Signet f erson Responsible at
4 .. Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
a1
i t l Q
o X
h
k
� �\ TOWN OF OU- ���`� c3UR�r
I �.... BUILDING PT,
Revie ''t
1
®ate
9
Septic Ins 10`a�
p Inspection Report
Office No. (518) 761-8256 Date Inspection iv :
Queensbury Building&Code Enforcement Arrive: a part: a
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia s
NAME: - 1 E Lb P NO.: _o 7 601
LOCATION: ODT Z= I SP CT ON:
RECHECK:
Soil T n _
Comments and/or diagram
T of ate • unici r
Waterline se on distance ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total lengthft,
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 T41
Distribution Box I
Opening Sea : Y P-affiU—
End Ca
Inlet/Outlet Pipes&Baffles Y N
Location Se rations
Foundation to tank ft.
Foundation to absorption 1.6 ft.
Separation of Pits
Conforms as p2r Plot Plan N
Engineer Report and As-Built Y N
Location of System on Property:
rout Rear Left Side Right Side
Middle Fro Middle Rear
m
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05