2015-354 .4111" TOWN OF QUEENSBURY
t--4to
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150354 Date Issued: Wednesday, August 12, 2015
This is to certify that work requested to be done as shown by Permit Number P20150354
has been completed.
Tax Map Number: 523400-295-018-0002-031-000-0000
Location: 9 CROWNWOOD Ln
Owner: PAUL& JEANETTE ARENDS
Applicant: PAUL & JEANETTE ARENDS
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
property owner of the responsibility for compliance with Site Plan, �d
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
4111111hi 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150354 Application Number: A20150354
Tax Map No: 523400-295-018-0002-031-000-0000
Permission is hereby granted to: PAUL&JEANETTE ARENDS
For property located at: 9 CROWNWOOD 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 Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: PAUL& JEANETTE ARENDS Septic Alteration Residential
9 CROWNWOOD Ln Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
MORNING STAR SEPTIC
793-2290 744-8139
107 JEWELL Rd
GANSEVOORT NY 12831-0000
Plans&Specifications
BP 2015-354
Residential Septic Alteration- new leach field only EZ flow-1202
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 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 .iration da e
Dated at the To n of i s.f ;4 vt �,esday,August 12,2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL APPLIC CP C 1 I [=• : Use Onl
•ei ed
DATE: _ / S( 6 I S AUG 1 0 Ui ap ID
�`�" 2015 �,
TAX MAP ID: 2J5, ��- ,�-31 No. aBigiaM
TOWN OF QUEENSBU-Perm Fee r1
ZONE: BUILDING& CODES
APPLICANTS ,rf PHONE/E-MAIL y t�/g 13 9
ADDRESS /v G/�cM.�y�. /Lv� ✓j owe-e..� �/
INSTALLER/ PHONE/E-MAIL
BUILDER
OWNER t / .1 292 WO CD
ADDRESS
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE:
PHONE/E-MAIL
RESIDENCE INFORMATION1")RvA9 � FO YVA--E-�
Year Built #of bedrooms X gallons peri bedroom =total Daily flow
1980 or older Garbage grinder installed Yes No
1981-1991 3 1 5c) y s Spa or Hot Tub installed Yes _No
1992-Present
PARCEL INFORMATION
Topography )L Flat rolling Steep slope %Slope
Soil Nature < Sand Loam Clay Other
Groundwater At what depth:
Bedrock/Impervious material At what depth:
Domestic Water Supply X Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank size At," gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub
System Absorption field with#2 stone Total length /qt.-9 ft.;Each Trench 6z F z toma, -(2P 2-
Seepage
Seepage Pit with#3 stone How many: ;Size
Alternative System Bed or other type:
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 known by or on behalf of an applicant,shall be void.I have read the regulations and agree to
abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
PRINT NAME: Fi�A)kCi ti c 5PA DATE: cLud., ti /4-
SIGNATURE: ' - c4 DATE: <<
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014
_ _ I
. . f Queensbury Building &Code Enforcement
Office No. (518) 761-8256 ‘t4f.ce,, , 1(,)061/
Septic Inspection Report —370.
Inspection request received: _.;s� �.5/
11,, L -- -
Name: i/ / ��, = , ./ '-
-lvr� � Inspected on: �i�� �_,
Location: ( ' iidOe" �'� Arrive: •� r . ►.. .
---35
v
Permit No.: �)/5 -35 Inspector's Initials: 41111111101"
C• ments and/or dia•ram
Soil T •e: Sand •.m/Clay
Type of ►a dun' -:• - Water FP2c T'RA n
"/
Waterline separation distance ft. � _ '�-Z\ — `2n_
Well separation distance ft. 11�
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO] O� Ac — f\
l Absorption Field: Total length 4(i0 ft.
Length of each trench 6:1d ft.
Depth of trenches 2——) ft. r F 6 i 51-m
Size of Stone "L F1 �7 6' h—c M 69___ .3.__ E j.2-,^
< ���J
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank - A.1: Ut►• eJ(,
Tank to Distribution Box vitt A -35-
Distribution Box to Field/Pit / Lit, 6 DR-. 35 "Co E ft Fid L- \_.M1,11.1j
Opening Sealed: N
End Cap =/,,, N
Inlet/Outlet Pipes&Baffles �
Manholes 12"or less below grade v N/
[provide extension collar if Yes] _Y✓N
Location/Separations
Foundation to tanklt� .
Foundation to absorption 7.-5—ft.
Separation of Pits ft.
Conforms as per Plot Plan ( N
Engineer Report and As-Built _Y_N
ETU Maintenance Contract provided Y_N
Location of System on Property:
Front Re Left Side Right Side Middle Fron Middle Rear)
S stem Use Sta s:
Approved .
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
Dv
CIED �JCE .
3DB AUG 10 2015 1 P.)
, ‘)..•t i`f TOWN OF QUEENSBURY
BUILDING &CODES
FILE. COPY
•- it/j4/5 . .'t,i)( \( ,A,_
24' /-- 1,0
_j r
A\ 6o
10 A fdpl.rn lO t
1
TOWN OF QUE -S: i`Y
BUILDING & CSD 41'
Reviewed By: /mak `�- P L-
Date: +Mir
)_____/
09CH-
1 ' 1.-' ())
SEPTIC_PL T Ati)
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES,WELLS,TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT. H AVEHIERS SORAM LY
MEASURED THE DI AN- j �H'
IGNATURE E
AlZ iia /./.\.}-\\ .--... L/7)._() )._____
CiTOr?Oa 6ec>2__