2010-133 TOWN OF QUEENSBURY
^w 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100133 Date Issued: Wednesday, April 14, 2010
This is to certify that work requested to be done as shown by Permit Number P20100133
has been completed.
Tax Map Number: 523400-301-014-0001-098-000-0000
Location: 76 LAMBERT Dr
Owner: WALTER & MARGARET STEIN
Applicant WALTER & MARGARET STEIN
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
.41011h
Fora 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100133 Application Number: A20100133
Tax Map No: 523400-301-014-0001-098-000-0000
Permission is hereby granted to: WALTER&MARGARET STEIN
For property located at: 76 LAMBERT Dr
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: WALTER& MARGARET STEIN
76 LAMBERT Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans&Specifications
2010-133
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 09, 2011
(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 T n o uee ur� r'` . , - pril 09, 2010
�,Vf 14
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
j� ` `�!_.�----_ OFFICE USE ONLY -:,:cj _ n
TAX /. / 4f,�'��-.� � '� Y,�,.;�.MAP NO. '�j� S��
PERMIT NO. PERMIT FEES_ 11i app ? d �f f/.
APPROVALS: �. �
-_-_- TOWN CLERK ' L.
-- - --• '-" ill';':- "`- -�..
APPLI
CATION FOR SEPTIC DISPOSAL SYSTE �� �--
MPERMIT: "..
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BE
PERMIT.
BEFORE ISSUANCE OF A VALID
OWNER: _ .�
— INSTALLER: , 1
ADDRESS: if 11
i ....•....., ms...".m. ADDRESS: L 0 tit,-c• i•
PHONE NOS. — , •
PHONE NOS. A — # V
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
GARBAGE G
1980 or older X 150 gallon per bedroom =
1981 -1991 RIN jR��
40
X 130 gallon per bedroom INSTALLED?-present X 110 gallon per bedroom -
SPA OR HOT TUB
PARCEL INFORMATION: INSTALLED?
✓ TOPOGRAPHY:
Flat rolling Steep slope4 /oo
✓ SOIL NATURE:Sand Slope,��
Loam/
( Clay�/4- Other_____________.
ther
✓ GROUNDWATER: � �
At what ,
-
depth? _
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth7Q _
✓ DOMESTIC WATER SUPLY:
Municipal Well_ Th,�__�
(If well: Water supply from any septic
V PERCOLATION TEST: Rate is system absorption is —__ft)
per minute
er inch.
(Test to be completed by a licensed professional engineer or archit
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposalect.)
9systems must be designed by
a licensed professional engineer or architect (unless installed in a Planning Board
TANK SIZE: /a_z_2_0__ approved subdivision).
GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to
each garbage grinder, spa or whirlpool tub. the size of the septic tank for
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total lengt ft /
Each trench
i
❑ SEEPAGE PIT(S) _Lk___Lk__X�_
(WITH NO. 3 STONE) How many?
❑ ALTERNATIVE SYSTEMSize?
Bed or other type? I /
❑ HOLDING TANK SYSTEM Total required capacity?
_ALA__
Tank size?___&±___. Number of tanks?
€; NOTE: ALARM
li SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A
APPROVED ELECTRICAL INSPECTION `�'•`'•�`"�''�
AGENCY. PLEASE REVIEW LIST PROVIDED. TOWN
For your protection, please note that pursuant to Section 136-29 of the Code of the T
.............................................::
permit or approval granted which is based upon or is nrnn*,,,4 Own of QUeenCh::ry
failurR to rn•al.., -- . . .
(2:co) / -3 fi--id.?
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ m rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: . PERMIT NO.: �G' /3—'
LOCATION: • 6 „/; . INSPECT ON: L/ — 7—/
RECHECK: . /1151_
Comments and/or diagram
Soil Type: / Loam/Clay
Type of Water: d.Ski &/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length 7_0-C> ft.
Length of each trench 4 b ft.
Depth of trenches Z.A- ft.
Size of Stone
Seepage Pits: Number �(
Size: 'v
Stone Size: id--
Piping Size Type
Building to tank i5V (.
Tank to Distribution Box 1�
Distribution Box to Field/ Pit ` L S%tt__3 r
Opening Sealed: X N
End Cap —V/YN
Inlet/Outlet Pipes&Baffles 1//Y N
Manholes 12"or less below grade V Y
[provide extension collar if Yes] Y V Ni}
Location/ Separations c)C7-'dV_ �
1�
Foundation to tank 1-0 ft.
Foundation to absorption tet, S ft.
Separation of Pits 1 A" ft.
Conforms as per Plot Plan X_N
Engineer Report and As-Built d Y N
ETU Maintenance Contract Y_ N
provided
Location of Systz,' on property:
Front Rear Left Side Right Side Middle Front Middle Rear
stem Use S • s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Fomis\Septic Inspection Report_03 29 10.doc
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