2005-668 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: P20050668 Date Issued: Wednesday, August 24, 2005
This is to certify that work requested to be done as shown by Permit Number P20050668
has been completed.
Tax Map Number: 523400-309-010-0001-029-000-0000
Location: 23 PINE St
Owner: SCOTT & SUZANNE CARPENTER
Applicant: SCOTT & SUZANNE CARPENTER
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: P20050668 Application Number: A20050668
Tax Map No: 523400-309-010-0001-029-000-0000
Permission is hereby granted to: SCOTT& SIVANNE CARPENTER
For property located at: 23 PINE St
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. i Type of Construction Value
Owner Address: SCOTT & SUZANNE CARPENTER
23 PINE St Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
STONE INSTALLATIONS
14 WESTLANDS Ave
OI TEENSBI TRY. NY 12904-0000
Plans&Specifications
2005-668
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, August 22, 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 To eens Mb.,Auaust 22, 2005
SIGNED BY IV- 1414 for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit— Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation:
File Permit No. v�
Tax Map No,
W
Fee Paid
Owner's Name: �t1 Z tc,.'�e, t& t f—
/� .................................................................................. ..
Address:
2. INSTALLER'S NAME S4at /6//4,T/Q�S PHONE NO. -7
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate #bedroom(s) and multiply #of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year f House: No. of Bedrooms x Computation = Total Daily Flo
!fv J �X ��f�,
�11f980 or older x 150 gal/bdTm =
1980- 1991 x 130 gal/bdrm =
1991 -present x 110 gal/bdrm =
Garbage Grinder Installed yes_ / no l
Spa or Hot Tub Installed yes_ ! no
AUP 1 8 2005
4. PARCEL INFORMATION: (circle applicable information& indicate'Measurements)
To h S ' ature Ground Water Bedrock or In ��rvibus Material =moo tic Water Supply
it sand at what depth at whit depth munici
ingAft" feet AFL_feet well
Steep slope clay if well; water supply
slope other from any septic-.system
depth: absorption is 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: / D gallon (min. size 1,000 gal.) 3
Tile Field: each trench ft. Total System Length: ft.
Seepage Pit(s): number of size of each: ft. by
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: length andlor size b/-�---F), e-`L'�•�i •Kvod
--s
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: 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 Qu nsbury Sanitary Sewage Disposal Ordinance.
gnatu o esponsible person Date
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
r POND
•
'11Q1!i4'�` �#w1fa�
Eke +SF.
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS ,
PO
i.
*+r�4
a �! �Si1tf'�Y 7RS
$A7MCFfJIY
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Septic Inspection Report
Office No.(518)761-8256 Date Inspection re est eceiv d-
Queensbury Building&Code Enforcement Arrive: m/p art:
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi s:
NAME: �( � IT NO.: C
LOCATION: PE ON:
RECHECK: _� L
Comments and/or diagram
Soil Typf San Lpam(Clay
Type of umci W ater
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft. � E
-Length of each trench - c� Z ft-
Depth of trenches Z — ft.
Size of Stone R h Q
Seepage Pits: Number
Size: x
Stone Size:
piping Size Type
Building to tank C;
Tank to Distribution Box 1
Distribution Box tc 'eld/Pit
Opening Sealed: artial
End Caps
Location/Separations
Foundation to tank
Foundation to absorption
Separation of Pits ft. �� M rc-L
Conforms as per Plot Plan
En 'veer Report and As-Built V11Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Fr Middle Rear
S stem Use Stat
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
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have seen or observed, or believe I saw evidence of,
Ail objects such as houses, wells, trees, fences, etc.,
i shown on this document. I also represent that I have
persona measured distances set forth on the diagram."
�K S�: T RE DATE