2001-813 TOWN OF QUEENSBURY
vrso742 eensb
Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
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Permit Number. P20010813 Date Issued: Monday, December 11, 2006
This is to certify that work requested to be done as shown by Permit Number P20010813
has been completed.
Tax Map Number. 523400-302-005-0001-085-000-0000
Location: 21 OLD AVIATION Rd
Owner. PATRICIA STRAINER
Applicant: PATRICIA STRAINER
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 ther--- P 4
property owner of the responsibility for compliance with Site Plan, ay
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.
T. TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
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BUILDING PERMIT
Permit Number: P20010813 Application Number: A20010813
Tax Map No: 523400-302-005-0001-085-000-0000
Permission is hereby granted to: PATRICIA STRAINER
For property located at: 21 OLD AVIATION 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: PATRICIA STRAINER Septic Alteration Residential
21 OLD AVIATION Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY,NY
Plans &Specifications
2001-813
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, October 31,2002
(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 QueTnsbury; Wednesday, October 31,2001
SIGNED BY for the Town of Queensbury.
Director of Buil g& de Enforcement
Application for Permit-Septic Disposal System
Town of Oueensbury 742 Bay Road Oueensburv, NY 12804 (518) 761-8256
1. OWNER INFORMATION: ____.._....___............_.... _.
Office Use
Location of installation: c)7 61
File Permit No.c>rn
Tax Map No. / / Oa
w Fee Paid 675
Owner's Name: � � � �C'9'�"�'1 'e r
Address: p I 0C/a u-Z t v 4'
2. INSTALLER'S NAME :4_ Inc S S( t'e L- PHONE NCIDCT 3
01
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate #bedroom(s) airebniAt.s)y# o
bedrooms with applicable gallons per bedroom to equal Wit; • a A ►4NSBURy
fVD CO®�
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older 3 x 150 gal/bdrm = ((C.-O
1980- 1991 x 130 gal/bdrm =
1991 -present x 110 gal/bdrm =
Garbage Grinder Installed yes— / no n'
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
r �,
•
s.graphy , ature Ground Water Bedrock or Impervious Material /omest3c ter Supply
Flat san at�yZay municial
Pepth at what depth
': ing am /l,('I feet feet
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:_ gallon (min. size 1,000 gal)
Tile Field: each trench ft. Total System Length: .ft
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: 6. t '`• 1 1-i°Mength and/or size
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.
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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.
g/(/' l� 0 )&or
Signature of responsible person Date
Septic Inspection Report
Office No. (518)761-8256 Date Inspection reques -ce. -::
Queensbury Building&Code Enforcement Arrive: am/i I-,Part: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: /
NAME: Qc \c PE' I NO.: 1 . Y��_
LOCATION: 9,101,c ,�Vir.'
INSPECT ON: 1 -' [l9' 1)
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Munici r.1/Well Water
Waterline separation di•to,ce ft.
Well separation distanc: ft.
Other wells: _ _ft.
Absorption Field: Total 1-ngt. - ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number _
Size: x
Stone Size:
Piping Size Type \ W�
Building to tank 46.U--4``2N�
Tank to Distribution Box OVA\
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial /
Location/Separations
Foundation to tank ft.
Foundation to absorption _ ft.
Separation of Pits _
Conforms as per Plot Plan 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
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queen_sburyNY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name paT is l R 6T-E al N)F.01
Location 21, ( I___ n�1 nu3 ED
Date lZ—(o-t t Permit #7c ( j3
SOIL TYPE: and-,b.oam-Clay-
Results of Perc ation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: A/��
ABSORPTION FIELD. Total e'�grth�L <-fN�
Length of each tr nch P
al
Depth of trenches r 7/_�fir' + T
Size of stone \ F A\
SEEPAGE PITS: Numbe - \
Size - f' . x ft.
Stone size
PIPING: E Size Type
Bldg. to Tank 4L/c.,; °LI,J I,pa c;
Tank to Dist. Box j,�SPP— -4-5-
Dist. Box to Field/Pit 'I P t—rc� EjTj
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank to feet
Foundation to Absorption feet
Separation of Pits fe
Conforms as per Plot Plan Y No
LOCATION OF SYSTEM ON PROPER :
(circl : - -
Front Rears ;i •ht Side
Middle Fr:'z4/7ddle Rear
COMMENTS:
ti�� 1�11��v�
SYSTEM USE APVROVEf:11 ES NO
Arrives • p; i►,
Depa• ed: ,;, ri <.
Bu ding rector
i
e \\\a-, j
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name _e C q <'6EaP, EC=R
Location 7.1 CAA) f:W t C
Date 17 --(p— 1 Permit #2.c` — _3
SOIL TYPE Sand oam-Clay-
—
Resul is of Percolat o \Test-
(if applicable) Rat--Mi\ ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To al Length
Length of each trenc '
Depth of trenches 1 1 I(�' ICo �{
Size of stone '
SEEPAGE PITS: Numbe
Size - f ft.
Stone size
PIPING: Size Type
Bldg. to Tank %1 OCR ai?
Tank to Dist. Box ‘+ t! cr
Dist. Box to Field/Pi %9C« E E
Openings Sealed? No Partial
LOCATION/SEPARATIONS:
Foundation to Tank \C3 feet
Foundation to Absorption 'j feet
Separation of Pits fee
Conforms as per Plot lan . Yes o
LOCATION OF SYSTEM 0 PROPERTY: —
(circle one)
Front 'ear Right Side
Middle on idle Rear
COMMENTS: `_
bV\ To I66w
SYSTEM USE APPROVED S 0
Arriv- e . d
Dep ted AA ( L
AiAw:-" llding Ins,e((or
TOWN OF QUEENSBURY .
BUILDING. &_CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name _ 1 20DEA UX �j t�►i a1E
Location 13 OLD ivIlpT1e* RD
Date 1z.,4 -61 Permit # `/x)1 — \3
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test
(if applicable) Rate-Minut••/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total eng h
Length of each trench
Depth of trenches
Size of stone 1111
SEEPAGE PITS: Number- V
Size - ft. x / ft.
Stone size 4
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Ye. No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorpt on feet
Separation of Pits feet
Conforms as per Plot Plan . Yes No
LOCATION OF SYSTEM ► PROPERTY:
. (circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS: L Ft‘i cT— Cif C�J C►J
L TE
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' SYSTEM USE APPROVED: YES NO
Arrived: ,
Depar
Bu lding Inspe r
Septic Inspection Report
.: Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: a Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: 3 PERMIT NO.: 2 / ` i3
LOCATION: 7 ( 00 Ire 1r10)/i�� � INSPECT ON:
RECHECK:
Comments and/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 length _ft.
Length of each trench ft.
Depth of trenches _ -_ft.
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 Cap
Inlet/Outlet Pipes&Baffles __,__Y T N
Location/ Separations
Foundation to tank ft.
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:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use ttus:
/ Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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OCT 3 0 2001
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TOWN OF QUEENSBURY
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BUILDING AND CODE
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