2006-486 Alb TOWN OF QUEENSBURY
742 Bay yRoad,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20060486 Date Issued: Wednesday, January 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20060486
has been completed.
Tax Map Number: 523400-301-008-0002-037-000-0000
Location: 416 AVIATION Rd
Owner. RICHARD & TERESA HACKETT
Applicant RICHARD & TERESA HACKETT
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 /�
�'d s.
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.
01001ek
TOWN OF QUEENSBURY
417 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building Sc.Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060486 Application Number. A20060486
Tax Map No: 523400-301-008-0002-037-000-0000
Permission is hereby granted to: RICHARD &TERESA HACKETT
For property located at: 416 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: RICHARD &TERESA HACKETT Septic Alteration Residential
416 AVIATION Rd Total value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans&Specifications
2006-486
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,July 12,2007
(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 Que bu19 1i.We .est ,y, July 12, 2006
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
���// ‘a—� Z " OFFICE USE VNL`-! b �f ,VULF 7 :V TAX MAP NO. PERMIT NO. PERMIT FEE � O F Cllfl; tv�t3
I3l1ILDING AND URY
APPROVALS: ZONING TOWN CLERK ; ; CODE
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. �� r
OWNER: V2,r& f 1 INSTALLER: /71t-z-L,....---7) ! d�
ADDRESS: LUG G 0' e . k`' ADDRESS: !V 7 A ��✓J - ar u:wJt*/�1�
PHONE NOS. 7 Q 3 L u PHONE NOS. 79-3 2 'L 3
LOCATION OF INSTALLATION: •�a-rns2_
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older i '3 ? X j 150 gallon per bedroom = Z/5-0 INSTALLED? ---
1981 -1991 ! X I 130 gallon per bedroom
! t I SPA OR HOT TUB
1992-present I I X . 110 gallon per bedroom INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: CrLT21,,-,AOLLING STEEP SLOPE %SLOPE
✓ SOIL NATUR 'SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPALS WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE 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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK: /OX GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: n /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM: (If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: /tC GAL.
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 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes@queensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
I 10 Ir!" �^ ` - _ - v www.queensburv.net
S gnature of Person Responsible Date
' b Jk.; Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
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Septic Inspection Report /•
Office No. (518) 761-8256 Date Ins.- io -• - - •.: D =
Queensbury Building &Code Enforcement Arrive: a .ryj Depart: �� 'ji
742 Bay Rd., Queen bu , NY 12804 Inspector`s Initia . / Q i _
NAME: lJ , IT NO.: roc __ Vw
LOCATION: '// 4p,cv(L f �z/ •ECT ON: IFY
ordo e006,/
RECHECK: !I
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. OtYC
Size of Stone
Seepage Pits: Number
Size: -----x-�----�-
Stone Size: _ ---
Piping
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y I N/ Partial
End Cap
Inlet/Outlet Pipes&Baffles _^.Y 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 Status:
/Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
°43bcptA
Septic Inspection Report
Office No. (518) 761-8256 Date Ins 'on r-• es, - -iv-•
Queensbury Building &Code Enforcement Arrive: 'a 00. A' •-mart l= '')L) a m
742 Bay Rd., Queensbury, NY 12804 Inspecto s Initial-
NAME: RIC-C1 \-‘1;CETT. 'ER IT NO.: NO —'1-{
LOCATION: Lk\le PQ1 fl1)c 9S) �N 'ECT ON: 7—t2— O n
RECHECK:
Comments and/or diagram
Soil Ty, ••• •- Clay
Type of Water unicipal ' Well Water
Waterline separ.i• . •• ft. ` �
Well separation distance ft. 1 1 )5.1--f)uu C (J ivE‘k)
Other wells: ft•
Absorption Field: Total length ft. , e1 D L �� "��
Length of each trench ft.
Depth of trenches ft. 111\N\iTh
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank I.k1/Tt►�6To 1} " .3C \- 4t`)
Tank to Distribution Box t-► " .'f)R 1--15�t*JC
Distribution Box t el / PitE�v-_\ ��
Opening Sealed. Y / Partial
End Cap
Inlet/Outlet Pipes &Baffles r N
Location / Separations
,6t_110„-> ttn ation to tank l' ft. To G r t.WE._ OV- 1 t•)l_ET C o' Z..
Foundation to absorption ft.
GPR --Separation of Pits _ ft.
Conforms as per Plot P : N
Engineer Report a ; As-Bui Y_ _N
Location of System on Property:
Front Rear Lei •e ''•ht Side
Middle Fro- Middle Rea
S Y em se us:
• Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 116/05
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Development Office
0 Town of Queensbury • 742 Bay Rd.
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Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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