2007-725 TOVN 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. P20070725 Date Issued: Tuesday, November 27, 2007
This is to certify that work requested to be done as shown by Permit Number P20070725
has been completed.
Tax Map Number. 523400-302-014-0001-069-000-0000
Location: 28 PERSHING Rd
Owner. BLOSSOM BITTMAN LE
Applicant: BLOSSOM BITTMAN LE
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: P20070725 Application Number. A20070725
Tax Map No: 523400-302-014-0001-069-000-0000
Permission is hereby granted to: BLOSSOM BITTMAN LE
For property located at: 28 PERSHM Rd
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: BLOSSOM BITTMAN LE
Septic Alteration Residential
JEFFREY BITTMAN, TRUSTEE
28 PERSHING Rd Total value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2007-725
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,November 27, 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 th of Qu b}�ry; e ` ' '/a y,November 27,2007
SIGNED BY ice" for the Town of Queensbury.
Director of Building&Code Enforcement
�____ OFFICE USE ONLY '____________________' i__ _________________"
,
0 TAX MAP NO. PERMIT NO. RMIT FEE
0 APPROVALS: ZONING TOWN CLERK 0, ;
"
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: �I U / i / /LL��.� INSTALLER: `,��•�� j �C �� i
ADDRESS: I'A- ADDRESS: we
PHONE N05. Cx
p� PHONE NOS. :2/�?, -��/
LOCATION OF INSTALLATION:
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?/�Z/11&-
DOMESTIC WATER SUPLY: Municipal 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: /&0
GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X.
❑ 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.
TOWN OF QUEENSBURYT.
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Septic Inspection Report
Office No. (518) 761-8256 Date ll.nspectio uQueensbury Building &Code Enforcement Arriv a p rt: a
742 Bay Rd., Queensbury, NY 12804 Inspecto s In '
NAME: -A' ry1 RMIT NO.:
LOCATION: 2 INSPECT ON:
RECHECK:
Comments and/or diagram
Sal T SandI-Clay
Type of W unici ell Water
Waterline se par nce
Well separation distance ft.
Other wells: ft•
Absorption Field: Total length ft.
Length of each trench ft•
of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Buildi to tank c '' thhICA
Tank to 9
Distribution Box!ql9ejdPit
Openins SealeVYJPN1 Partial
End Ca
In) Outlet Pipes&Baffles Y N �
Location Separations
Foundation to tank ft.
Foundation to abso ion ft•
Separation of Pits ft•
Conforms as r Plot Plan Y N
E ineer Re rt and As-Built Y N {� � � ,
Location of System on Pro
Front Rear 'Left Sid ght Side TBui
Middle Front Middle Rear
Approved
Partial Approved and needs to be re-inspected, please call t &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05