2006-697 TOWN OF QUEENSBURY
wors742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20060697 Date Issued: Wednesday, January 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20060697
has been completed.
Tax Map Number: 523400-308-010-0001-004-000-0000
Location: 20 LINETTE Ln
Owner. DONALD & ANNA SMITH
Applicant: DONALD & ANNA SMITH
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 Q„,„9 4 I
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.
ea TOWN OF QUEENSBURY
01-Zi 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060697 Application Number: A20060697
Tax Map No: 523400-308-010-0001-004-000-0000
Permission is hereby granted to: DONALD &ANNA SMITH
For property located at: 20 LINETTE Ln
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 Queens bury Zoning
Ordinance. Type of Construction Value
Owner Address: DONALD &ANNA SMITH
20 LINETTE Ln Septic Alteration Residential
QUEENSBURY, NY 12804-0000 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
SANITARY SEWER SERVICE
Plans &Specifications
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, October 11, 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,6f Quer buWeyiips I ay, October 11, 2006
SIGNED BY V 1 for the Town of Queensbury.
Director of Building&Code E o cement
r .0 6 .-‘?-7
OFFICE USE ONLY /OA 0C, ;
TAX MAP NO. PERMIT NO. PERMIT FEI2 ,61)
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE ORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSU NCE OF A -ALID
PERMIT: j� �J .y�� /7,
OWNER: ,/fr�/ / ' Al//� INSTALLER: ' .4 / i /�< ' eGve_c_ 62 Lo"Ce
ADDRESS:7D < if e.2.7-e L/�IAle. ADDRESS: /16) 30X 2-2-411..../ e6---i p
PHONE NOS. 1.7V? Q e P.2.- "— PHONE NOS. '796 — 0 J 5-3
LOCATION OF INSTALLATION: J-`-' L/A_e-le_ L,,i, _
NO.OF , RESIDENCE INFORMATION:
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW I
BEDROOMS .1
GARBAGE GRINDER
1980 or older I X 150 gallon per bedroom = INSTALLED?
1981 -1991 k / r X 130 gallon per bedroom =
i SPA OR HOT TUB
1992-present E i X I 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION: /
✓ TOPOGRAPHY: FLAT "LING t/ STEEP SLOPE %SLOPE
✓ SOIL NATURE: AN
S D LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? P//fr BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH? /
✓ DOMESTIC WATER SUPLY: MUNICIPAL 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 theseptictank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK: / 9° 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. -A//` gi7,-4Ce ,i Wr U n,
CL/
✓ SIZE OF STONE TO BE
USED; # /.DEPT OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: IV .1. LENGTH AND/OR SIZE
V
✓ HOLDING TANK SYSTEM:(If required) NO. •F TANK : /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: 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
e.7- •ury Sanitary Se Disposal Ordinance. codes@queensbury.net
a_ VISIT OUR WEBSITE FOR MORE INFORMATION
i°17/6
6 www.queensburv.net
Sig :ture ofi Person R nsible Date
' : Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
•
06-677
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TOWN OF QUEENSBURY
BUILDING & CODES.: -T.
REVIEWED BY _ •�
DATE (6 i
?coe4,t_7-7/
(7' -77/( :nl)
70//a/06
Septic Inspection Report
Office No. (518) 761-8256 Date I0, ; ion 'est received:
Queensbury Building &Code Enforcement Arrive: am/p` a art: am/pm
742 Bay Rd., Queensbury, NY 12804 Ins'-• i s Initials: e..J
NAME: S ill /,L_2%f
PERMIT NO.:
LOCATION: 20 (_;WP
7/ / ,t-e INSPECT ON: fr
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water � � 4":-P4 � �
Waterline separation distance ft. �'
Z--1^4 /dr
Well separation distance ft.
Other wells: ft. Oi✓L
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 Si; /1 zTpe ,l
Building to tank ,� �� 37
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: Y/ 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 n Property:
Front Rea Left Side Right Side
Middle n Middle Rear
System Use Sta :
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05