2015-156 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150156 Date Issued: Monday, May 18, 2015
This is to certify that work requested to be done as shown by Permit Number P20150156
has been completed.
Tax Map Number: 523400-301-014-0001-015-000-0000
Location: 7 PHEASANT Walk
Owner: ERIC LUSSIER
Applicant: ERIC LUSSIER
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 (" )J4
property owner of the responsibility for compliance with Site Plan, 9000P
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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
FON
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150156 Application Number: A20150156
Tax Map No: 523400-301-014-0001-015-000-0000
Permission is hereby granted to: RONALD & LINDA BAUER
For property located at: 7 PHEASANT Walk
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: RONALD & LINDA BAUER Septic Alteration Residential
7 PHEASANT Walk
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-156
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, May 12,2016
(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 To n of eens ; e , ay 12,2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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OFFICE USE ONLY
�7 , MAY 1 1 2015 J x
TAX MAP NO.J°l" '�-`-15 PERMIT NO. 261"D-1$5(° PERMIT FEE _ ,a,
• APPROVALS: ZONING TOWN CLERK TOWN OF QUEENSBURY 1
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:' BUILDING SII-DINS &Cor?rs
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT. ` /�
OWNER: b-Y t LLA (,1 U \ / INSTALLER: —L. - L -F'lyl S
ADDRESS: t I P" V ex,, 50\f� V(111 \\ ADDRESS: #1 Low? r WO(I' ^..
PHONE NOS. 01—.1 4 -0' 1 1 �, ' PHONE NOS. 33k--1,`K- 7 X- �r 9'4
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LOCATION OF INSTALLATION: 44-1 j efA 5 G ` V V t- - G\ K `�
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older ti L t X 150 = v
I \ INSTALLED?
1981 -1991 X 130 = 1 O SPA OR HOT TUB
1992-present N f X 110 = yC� — INSTALLED?
PARCEL INFORMATION: I
✓ TOPOGRAPHY: FLAT ROL ING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM lV CLAY 1V \\- OTHER
✓ GROUNDWATER: AT WHAT DEPTH? 'V ``
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA DEPTH?\r'Vtt
I DOMESTIC WATER SUPLY: MUNICIPAL WELL V (If well:water supply from any septic system absorption is: N 1� ft)
I PERCOLATION TEST: RATE IS W i-\ 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: \Q�� GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
„,�}�,,,5 each garbage grinder,spa or whirlpool tub.
SYSTEM T PE:
l .-} r \
ABSORPTION FIELD(WITH NO.2 STONE) Total IengthLO 0 ft. Each trench I X o
o SEEPAGE PIT(S)(WITH NO.3 STONE) How many? \, I1^ I Size? \‘
❑ALTERNATIVE SYSTEM Bed or other type? IV
❑HOLDING TANK SYSTEM Total required capacity? Pr Tank size? C v 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 abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewa e Dispo . cilc.!�•inance. codes(a�queensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
gnat- son Responsible Date www•aueensburV•net
Town of Queensbury* Community Development Office* 742 Bay Road, Queensbury NY 12804
Town of Queensbury Building & Code Enforcement V 16i)
Office No..,(518) 761-8256 2.�1.
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Septic Inspection Report
Inspection request received: 5\1" \15 II 1
Name: b .LICV Inspected on: �4t4 5
Location: 1-9\-Yu SC Wa,\k-,. Arrive: (2..%Z..'c a.m./p.m.
Permit No.: IFJ�\5lo Inspector's Initials: PA)
Comments and/or diagram
Soil Type: an Loam/Clay \
Type of Wa P: Municipal/Well Water �Yl�Y�1 S C��jS )
Waterline separation distance ft. J
Well separation distance / ft.
Other wells: i I . 50— 24
Well Casing Length 50'+/- ' N/A
[150'to well required if NO]
Absorption Field: Total length 'WO ft.
Length of each trench • ft. . .
Depth of trenches 45*-2.147 ft.
Size of Stone '-
Seepage Pits: Number
Size: )14Stone Size:
Piping Size Type
Building to tank — L >
Tank to Distribution Box 4 U 23'
Distribution Box to Field/Pit 4 ) �,41��„
Opening Sealed: N �'`Jxn-- lam-(
End Cap t✓' N
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade Y
[provide extension collar if Yes] Y N
Location/Separations
Foundation to tank ft. 0--Y -O
Foundation to absorption �k ft.
Separation of Pits
Conforms as per Plot Plan Y
Engineer Report and As-Built Y /¢.
ETU Maintenance Contract provided Y N
Location of Syste n operty:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Sta s:
Approve
Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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Pipeline Specialists JOB:
TEAM JP SHEET
NO.: OF
4 CALCULATED
Evereff J.Prescott, Inc. -
SCALE: BUILDING & • �' i/f•j
SEPTIC PLOT PLAN Reviewed By ., ' ,I Ar
I HAVE SEEN OR OBSERVED ALL OBJECTS Date. II �'/�_
SUCH AS H.OUSE1 WELLS, TREES,FENCES, ETC-- /
SHOWN 0•A I r M T. r ,,AA'E SET FORTH ON TH DIA RAM.
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• s- TOWN OF QUEE'NSBURY I
BUILDING & CODES