2005-335 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(zt Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050335 Date Issued: Wednesday, September 28, 2005
This is to certify that work requested to be done as shown by Permit Number P20050335
has been completed.
Tax Map Number: 523400-289-008-0001-072-000-0000
Location: 4 FIELDVIEW Rd
Owner: CHRISTINE PURDY
Applicant: CHRISTINE'PURDY
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, r:
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: P20050335 Application Number: A20050335
Tax Map No: 523400-289-008-0001-072-000-0000
Permission is hereby granted to: CHRTSTTNF,PI TRDY
For property located at: 4 FIELDVIEW 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. Type of Construction Value
Owner Address: CHRISTINE PURDY
4 FIELDVIEW Rd Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builders Name /Address Electrical Inspection Agency
BATEASE EXCAVATING
71 BIG BOOM Rd
OTTEENSBTTRY. NY 12804-0000
Plans&Specifications
20005-335
SEPTIC ALTERATION ( SEPTIC RELOCATION)
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, May 26, 2006
(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 Towxr b r ay 26, 2005
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System cv
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: /
.................................................................................. ..................
Office Use
Location of installation: '
File Permit No.(957;`�
Tax Map No. 7 a3 qg-'-173
Owner's Name: / yr
Fee Paid ZS j
r
Address: ��� /��.J �. /��SQ....... lam.`..... s.,......`s.... ................
2. INSTALLER'S NAME PHONE NO. 3&// '/3-276
3. RESIDENCE INFORMATION: (circle year of dwelling, indic to#bedroom(s)and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
80 r er x 150 gal/bdrm =
1980- 1991 vim— x 130 gal/bdrm = 32-0
-present x 110 gal/bdrm = c
Garbage Grinder Installed yes_ / no 7� RC C
IZM
Spa or Hot Tub Installed yes_ _ / no '
I
MAY 16 &T4
4. PARCEL INFORMATION: (circle applicable information&indicate measurementOWN OF QUEEN
BUILDING AND SBURY
h Im Soil Nature Ground Water Bedrock or ervious Material Domes 1
lat sa at what depth at what depth municipal
o ling to /_feet X/,w feet well
Steep slope ay if well;water supply
_%slope o er from any septic-system
depth: absorption is aa ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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: /2s� gallon (min. size 1,000gaI)
Tile Field: each trench :;a ft. Total System Length:
Seepage Pit(s): number of _ size of each: AIA ft. by (/,I- ft.
Size of Stone to be used: # �2- _ / depth or thickness , 5� feef
Bed System Size: Z/4 x �C i�
Alternative System: �tiJ,j� length andlor size ALL e=
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: ! Size of each: d gallons /TOTAL Capacity:_,b-gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 Queensbury Sanitary Sewage Disposal Ordinance.
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Septic Inspection Report
Office No.(518)761-8256 Date InspectionrreQueensbury Building&Code Enforcement Arrive: : m
742 Bay Rd., Queensbury,NY 12804 Inspector's InitiNAME: c—
,,d �JLOCATION: - , —
RECHECK:
Comments nd/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total len h ft. 1 a
Length of each trench
Depth of trenches ft. 1
Size of Stone
-Seepage 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 Caps
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan N
En ineer Report an s-Bu' Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Fr t Middle Rear
System Use St us•
Approved
Partial Approved and needs to be re-inspected,please call the Building& Codes Office
Disapproved
Last revised 1/6/05
Septic Inspection Report
Office No.(518)761-8256 Date Inspection re est c ve
Queensbury Building&Code Enforcement Arrive: m/p D art: a m
742 Bay Rd., Queensbury,NY 12804 Inspector's Initi _
NAME: IMA� IT NO.: jo 11
LOCATION: ��� r��L� PECT ON:
RECHECK: —�
Comments and/or diagram
Soil T : Sa o a
Type of Water: Municip Well W
Waterline separation distance ft.
Well separation distance ft-
1-Other wells: ft.Absorption Field: Total length ft.
Length of each trench s3co ft.
Depth of trenches + — ft.
Size of Stone A &0,
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Ri %% Q p�� ---
�3c)Y__ 21- y
Distribution Box to Field/ �� Q �V
Opening Sealed: Y/N arti
End Caps
Location/Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per P10 Y
Engineer Report&Qd As-Built Y N
Location of System on Property:
Fron ea Left Side = Right Side
Middle Front Middle Rear
System Use Statu
Approved
Partial Approved and needs to be re-inspected,please call the Building& Codes Office
Disapproved
h�ti T EF cam
'� M 5= ► w�Last revised 1/6/05
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COPY
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�011VN 4F QUEENSBURY BUILDING DEPARTMEN?
`' Based Al ._ - on our limi examinati___�r—___
not s wi our comments shalt
construed as indicating the
plans and
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