2015-166 .4110% TOWN OF QUEENSBURY
owBay742 Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150166 Date Issued: Monday, June 08, 2015
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This is to certify that work requested to be done as shown by Permit Number umbe P20150166
has been completed.
Tax Map Number: 523400-304-017-0001-045-000-0000
Location: 14 KATHERINE Ave
4
Owner: EUGENE PRATT
Applicant: EUGENE PRATT
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 (DJ 4 4't
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
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742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150166 Application Number: A20150166
Tax Map No: 523400-304-017-0001-045-000-0000
Permission is hereby granted to: EUGENE PRATT
For property located at: 14 KATHERINE Ave
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: EUGENE PRATT
14 KATHERINE Ave Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-166
residential septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday, May 15,2016
(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 d.te.)
Dated at the T wn of ee ur jay, May 15,2015
SIGNED BY //�� for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT
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V Office Use Only
M 4, Z Q I
DATE . Received
304TAX . 17 - I Tax Map
MAP ID A� 1 4 t Na. JLto �C�
20 15-11rL,o
14GI ovie ec r remiit Fes-
LOCATION OF INSTALLATION out ,..„ e
u4ee'15 / ,'ri( TOB JILD G 4.CODES
APPLICANT EctaY c K.. tai' (76- PHONE/E-MAIL q. 744- 4411
ADDRESS 0 VV al/CI L o I'e CWVIç �N Y e lg `InPC C I L Cp lfh.,�
INSTALLER/BUILDER: (� ke(,1) PHONE/E-MAIL S-I V 717 `�r,,
7 77
ADDRESS: (i; bAic
�� 0 y f V � I P _ 2 7 �j
OWNER (A?J e t L 4 ` PY c � PHONE/E-MAIL�/C 2(;_&-7 --/
Address ) k k4tivvtt2 S"I ec i co,,ee°141l �
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: Ed LQ�C)i✓I 1- 1 n& PHONE ?4 - ill
RESIDENCE INFORMATION 1
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older I_ I.30 �j� Garbage grinder installed _Y XN
1981-1991 f V Spa or Hot Tub installed _V )(fV
1992-Present
PARCEL INFORMATION
Topography iXat rolling Steep slope %slope
Soil Nature Y Sand Loam Clay Other
Groundwater At what depth? , - > f? '-t2e Is
Bedrock/Impervious Material At what depth? > , 1-
Domestic Water Supply Municipal \' ell(if well,water supply from any septic system absorption is 1 j O ft.)
Percolation Test Rate: 2. S per minute per inch(test to be completed by licensed engineering/architect)
1
PROPOSED SYSTEM FOR NEW CONSTRUCTION Reda c,64,164- I,e�� t•.e IC' �X)��'I�5 ssI}`pk,.I �i 101V.0
Tank Size /000 gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage gnnder or spa or hot tub)
System Type Absorption field with#2 stone Total length ft.;Each trench x
Seepage Pit with#3 stone How many: ;size 11
Alternative System I/ Bed or other type? / TeJ T 1 0 i 1 i hick✓ 3 e 6O c-
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received &approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to abide by hesen�/all r qujI.emee is of the Town of Queensbury Sanitary Sewage I ispo al Ordinance.
Print Name: t vd K. 121✓T1 Pe- Date: S. 1 4 11
Signature: 40. / ' Date:
Town of Queensbury Bui • ng&Co e Septic Disposal Permit July 2014
Town of Queensbury Budding & Code Enforcement 1 t't
Office No. (518) 761-8256 6 -(0
Septic Inspection Report
Inspection reque t received: L2\t\2_QA
Name: K-C #- Inspected on: tete, 2Q,15
Location: \A ►gu y\rv�) Arrive: 1 \-97q5 a.m./p.m.
Permit No.: l 5—1' mac to Inspector's Initials: C "-
Comments and/or diagram
Soil Type. Loam/Clay
Type of a er: Municipal/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 _9,1ft.
Length of each trench 4)- 2- ft.
Depth of trenches —b ft. — tNFt ilizool �
Size of Stone -�
Seepage Pits: Number h-)114--
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box Q,�� '
Distribution Box to Field/Pit A k.
Opening Sealed:
End Cap All N
Inlet/Outlet Pipes&Baffles _Y_N � k �) �
Manholes 12"or less below grade Y_N �-¢.!�
[provide extension collar if Yes] _Y N
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y f)V
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
ystem Use Sta
Approved
I,
arttalpp�oved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report0
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, . fNuellwcyoomrkplsiatnactee.with the Building Codes of
TOWN OF OUEENSBUH.
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