2010-485 f i
106` TOWN OFQ UEENSBURY
742 Bay y R oad,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Pe 't Number: ,P20100485 Date Issued: Monday, October 18, 2010
This i to certif3'that work requested to be done as shown by Permit Number P20100485
has b en completed.
Tax Map Number. 1 523400-301-017-0001-041-000-0000
Location: 528 WEST MT. Rd
Owner. DONALD & JOYCE LATTERELL
Applicant DONALD & JOYCE LATTERELL
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 thek"---
1
Jroperty owner of the ilesponsibility 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 br Zoning Board of Appeals.
��` TOWN OF QUEENSBURY
s 1E7 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100485 Application Number. A20100485
Tax Map No: 523400-301-017-0001-041-000-0000
Permission is hereby granted to: DONALD &JOYCE LATTERELL
For property located at: 528 WEST MT. 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: DONALD &JOYCE LATTERELL
528 WEST MT. Rd Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-485
septic alteration residential
PERMIT FEE PAID- THIS PERMIT EXPIRES:
$25.00 Thursday, October 06, 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 Toeensb ii sda , October 06,2010
SIGNED BY 14
for the Town of Queensbury
Director of Building& •de E orcement
y �I
ECEQWEO
Community Development Office _ 1 1("T 0 4 2U10
Town of Queensbury • 742 Bay Road • Queensbury, New Yo'k • gq,.�,,,
WN OF QUEENSBURY
BUILDING& CODES
Office Use Only �j (TAX MAP NO. ^��` 0 7PERMIT NO. L' ,;}- PERMIT FEEis
APPROVALS: ZONING __ ___ TOWN CLER
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW FORE ISSUANCE FA VALI PERMIT.
r
OWNER: , IL/X ) &a it C-jLt_tL- INSTALLER: 1
ADDRESS: 2. _ 7 J Al22Sa—Irr-0 l� /i�J ADDRESS: t0 J X34- 1` - T
/
PHONE NOS.742— l / PHONE NOS.-_[C�r C)F-��__
LOCATION OF INSTALLATION: J 2 1 W. F J/CS/i PIA-) j
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BE/DOOMS (Gallons per bedroom) GARBAGE GRINDER_
1980 or older X 150 = 600 INSTALLED?___
1981 -1991 X 130 = SPA OR HOT TUB l�
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND_! LOAM_____ CLAY OTHER
I GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPALELL_ _(If well:water supply from any septic system absorption is:. ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (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).
TANK SIZE:1_00° GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO. 2 STONE) Total length ft. Each trench X
1 SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? 2- Size?I c_ t- r-�_
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
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
by these --• -II requir-ments of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
an'ary Sewa,e Ni-.osal r, Hance. codes(alqueensbury.net
/80/3
gnature of Pers n Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req -� - -d:
Queensbury Building &Code Enforcement Arrive: \ 5h a- I�uj 'depart: 7,_!, tl% amiJ
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials.
NAME: ‘- �-Tgat 1_ PERMIT MIT NO.: i G —1--I R�
LOCATION: 57 9 v.jT CAC t RC) INSPECT ON: 1(>-- l W HL
RECHECK: _,/
Comments and/or diagram
Soil Ty. : Sa.■.A oam/ Clay
Type of Water: Ilauti6l1PWell Water ,t,.,.��
Water) .e _.-• : ion distance Fa 1;T' 1' fm.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench _ft.
Depth of trenches _ft.
Size of Stone
Seepage Pits: Number z-_
Size: ? x 10
Stone Size: -'
Piping Size Type
Building to tank LI 'i '1C,i-\ '-{G
Tank to Distribution Lia ' ` . _,
Distribution Box to Field it l t) `) 312,
Opening Seale :
End Cap Y N
Inlet/Outlet Pipes&Baffles „N
Location/ Separations
Foundation to tank Ce .
Foundation to absorption U .
Separation of Pits ft.
Conforms as per Plot Plan Y_-__N
Engineer Report and As-Built _Y_ N
Location of System on Property:
Front Rea, Left Sid Right Sid Middle Front Middle Rear
Ss - - ., .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
I() 74'
Lrf 6.-07
Septic Inspection R- • •rt
Office No. (518) 761-8256 Date In pection - •u- , r- -' ed: /a/I 3V���g
Queensbury Building &Code Enforcement Arrive: •% am/p •.-•.It: \ arum
742 Bay Rd,Q�Q'ueensbury, NY 12804 r Inspector's I 6. -•
N ivs „Lai- `y v ER IT NO.: Ci/D- i f 85.5
LOCATION: W-UL,1 °L"/14 l/ INS•ECT ON: 76,4 lc }lye,0
RECHECK:
Comments and/or diagram
Soil T •-• ,,u,: .. +.m/Clay
Type of W. -r: Munic% , ell Water
Water me separation distance c?--c,;€ '1,,,\E7ft.
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 ft.
Length of each trench ft.
Depth of trenches ft. AV
Size of Stone
Seepage Pits: Number
Size: x !�%
t �
Stone Size: _7 qecA\e-c- 2-' /`"
Piping Size Type
Building to tank 4�' y
i
Tank to Distribution -- '1 R-n� 77
A` h "N � Cl"
Distribution Box to Field Pt t.'' bc) e. �
�
Opening
Y_ _N
End Cap _N
Inlet/Outlet Pipes&Baffles _1(„),____N
Manholes 12"or less below grade Y_N
[pro e e ] -__..-Y—.N
Location/ Separations I�
Foundation to tank x.11, `ft.
Foundation to absorption ) ft. -- ' VT
Separation of Pits _ ft.
Conforms as per Plot Plan Y—N
Engineer Report and As-Built Y—N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Si Middle Front Middle Rear
System Use Statu .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
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TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in • ;',.? ..( /
full compliance with the Building Codes of
New York State. .•2 ,'}' . ,
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THIS PLAN TO BE ON
PROJECT SITE AT
ALL TIMES FOR
THE DURATION OF ;-.i ..,..,-. N.' r'+' CD ...Cl.
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TOWN OF QUEENSBURY/
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BUILDING DEPARTMENT , 23
Based on,our limited examination,'compliance
with aur comments shall not tie construed as 2*0 1 -;:i--T-.7i
indicating,the plans and specifications are in
full compliance with the Building Codes of -i :�s a,
New York State. ' 1 _j : I ct,
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