2003-763 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,iNY 12804-5902 (518)761-8201.
Community Development-Building&Codes (518)761-8256
CER�IFIC AIM OF COMPLIANCE' '
I'ernciit Number: Pz0030763 Date Issued: Tuesday, September 16,2003
This is to certify that work requested to be done as shown by Permit Number P20030763
has been completed.
Tax Map Number:, 523400-300-01,6-0001-011.000�0000
Location: 216 FULLER Rd
Owner: DEBORAH FERRANTI
Applicant: DEBORAH FERRANTI
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF,QUEENSBUR
Director of Building&Code Enforcement
Al TOWN OF QUEENSBURY
742 Bay Road,Queensbuzy,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030763 Application Number: A20030763
Tax Map No: 523400-300-016-0001-011-000-0000
Permission is hereby granted to: DFBORAT-TFFRRANTT
For property located at: 216 FULLER 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: DEBORAH FERRANTI Septic Alteration Residential
216 FULLER Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name Address Electrical Inspection Agency
01JEENSBURY SEWER
JAY SWEET
Plans&Specifications
2003-763
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, September 15, 2004
(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 TI,wn of ee ajyu, 0� eptember 15,2003
SIGNED BY far the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit mit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation:
4Q
File Permit No.
Tax Map No.
F 45;
4'e ee Paid C5Z
Owner's'Name: /b Y\-i-"
.............................I..........1........................................ ..........................
Address:
.2. INSTALLER'S NAME PHONE NO. 7Y
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 of House: No. of Bedrooms x Computation = Total Daily Flow
19 8p-car PW0r--1 x 150 gal/bdim = 33
1980- 1991- x 130 gal/bdim
1991 —present x 110 gal/bdrin
Garbage Grinder Installed yes
Spa or Hot Tub Installed yes STP
4.' PARCEL INFORMATION: (circle applicable information&indicate measurements
qONNN OIF Arils091
Too P-rai3hv Soil Nature Ground Water Bedrock or Impervious Material ornestic Water Su ly
at'what depth at what depth
Rolling loam feet —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: /& u gallon(min. size 1,000 gal.)
Tile Field: each trench :�.......ft. Total System Length: /11, -.0...........
Seepage Pit(s): number of size of each: _ft. by_ft.
Size,�f Stone to be used: # depth or thickness feet
71
Bed System Size: x
Alternative System: ( P7 JA V-6+e t1T length andlor size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each:_gallons f 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 Queensbury Sanitary Sewage Disposal Ordinance.
9— /Z —
S at re of responsible person Date
._�� F CR)
Septic Inspection Report
Office No. (518)761-8256 Date Inspection re u t re d:
Queensbury Building&Code Enforcement Arrive: pinart:
742 Bay Rd., Queensbury,NY 12804 Inspector's Initia :
NAME: P IT NO.: 3
LOCATION: SPECT ON:
RECHECK:
Comments and/or diagram
Soil Typekefapd/)Loam- Clay
Type of i unici a Well Water
Waterline
Well separation distance
Other wells: ft.
Absorption Field: Total length ft,
Length of each trench
Depth of trenches
Size of Stone
-Seepage Pits: Number
EP 1 2 UO3
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
el it
Distribution,Box
1Y%
Location/Separations
Foundation to tank
Foundation to abs2Eption. —QID ft.
Separation of Pits
Conforms as per Plot Plan VY_N
Location of System on Property:
Front Rear Left Side ght Side
Middle Front Middle Rear
System Use St/us:
V Approved
Partial Approved and needs to be re-inspected,please call the*Building&Codes Office
Disapproved
L:\SueHemingway\Buflding.Codes.Inspection,FORMS\Septic Inspection Rep6rLdoc January 28,2003
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"1 have seen or'observed,.or believe I saw evidence of,
all oble cts such as houses,.wells,trees; fences, etc•,
4 shown on this document. I also represent that I have
personally measured the distances set forth on the diagram."
{ (F i
DATE , 1
I SIGN A RE .�
WEE
TOWN OF NSBURY
BUILDING & E
REVIEWED BY
DATE d~7
TOWN OF QUEENSBUPY BUILDING DEPARTMENT
Based on odr limited examination,
com liarr with our comments shall
not e construed as indicating the
plans and specifications are in full
compliance with the..Building.Codes
of New York State..'