2007-748 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. P20070748 Date Issued: Wednesday, December 12, 2007
This is to certify that work requested to be done as shown by Permit Number P20070748
has been completed.
Tax Map Number. 523400-279-015-0001-084-000-0000
Location: 17 RAINBOW Trl
Owner. WILLIAM & RITA COWAN
Applicant: WILLIAM & RITA COWAN
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&GAe7ement
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: P20070748 Application Number. A20070748
Tax Map No: 523400-279-015-0001-084-000-0000
Permission is hereby granted to: WILLIAM &RITA COWAN
For property located at: 17 RAINBOW Trl
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: WILLIAM &RITA COWAN Septic Alteration Residential
17 RAINBOW Trl
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
2007-748
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, December 11, 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 Town of Que nsbury; Tuesday, December 11, 2007
�`� 1 ; <F
SIGNED BY :^ ,, 1' for the Town of Queensbury.
Director of Building&6J)de Enforcement
�-_j_.�--'��-1--FFICE USE ONLY_________________________ i ;_____________________i
2/ ' ,/ / �J/jp
TAX MAP NO. PERMIT NO. PERMIT FEE ;
APPROVALS: ZONING TOWN CLERK
_____________________________________� i :---- ---_-_-
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: INSTALLER: — r d,
ADDRESS: ( �� scf Ii�Cc/� ��u,l ADDRESS: 41 t/f
PHONE NOS. PHONE NOS.—
LOCATION OF INSTALLATION:
NO.OF RESIDENCE INFORMATION:
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRIN
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom =
SPA OR HOB T�jB„,�]
1992-present X 110 gallon per bedroom = INSTALLED.,/C.//?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling X y Steep slope %Slope
✓ SOIL NATURE: Sand C Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?/v
✓ 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: 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: r
ABSORPTION FIELD (WITH NO. 2 STONE) Total length(� y 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.
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 nsbur . OR EMAIL
Queensbury Sani codes�gueensburv.net
y Sewage Disposal Ordinance.
— VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburV.net
Signature of Person Responsible Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
VA 'OWN OF QUEd�
B U I L D I . 0
Reviewed
ry Date- . .�.
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection est e' ed:
Queensbury Building&Code Enforcement Arrive: Z=StD a / a�
742 Bay Rd.,Queensbury, NY 12804 Inspector's Initial
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK: Of
Comments and/or diagram
Sal T nd m C
Type of Water: Municl I Well Wate
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total lengthft.
Length of each trench ft.
Depth of trenches
Size of Stone #k
Z—
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Tpe
-Building to tank
Tank to Distribution Box c
LAE
Distribution Box to Field P"t
Ope ing Sealed: artial
End Ca a
Inle Outlet Pipes&Baffles J _ZY—N
Location Se rations
Foundation to tank ft.
( i 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:
F t Rear Left Sid<Rigi
Side
Middle Front iddie Rear
*stpm
U 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
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r e ived:
Queensbury Building &Code Enforcement Arrive: 1 Depart: am pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial :
Lo A
NAME: EtMIT NO.: - 740
LOCATION: ' I14SPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam Clay
Type of Water: Municipal Well Water
Waterline separation distanceWell separation distance ft. U)
Other wells: ft.
Well Casing Length 50' + - Y N_N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x t�
Stone Size: � ���► �I `J J��
�r7Q5
Piping Size Type
U� v1^ L�
Buildingto tank �/
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y N
End Cap Y N
Inlet/Outlet Pipes &Baffles Y N
Location Separations
Foundation to tank ft. Q
Foundation to absorption ft. , ° 1 A
Se ration of Pits
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc