2009-109 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
E IFICATE 0.1F COMPLIXNCT
Pemlit Number. P20090109 Date Issued: Tuesday, April 21, 2009
This is to certify that work requested to be done as shown by Permit Number P20090109
has been completed.
Tax Map Number. 523400-296-013-0001-056-000-0000
Location: 151 MONTRAY Rd
Owner: ROBERT & DIANA MARTIN
Applicant: ROBERT & DIANA MARTIN
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Baatxl
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the t !
property owner of the responsibility for compliance with Site Plan, ° '""�
Variance,or other issues and conditions as a result of approvals by the Ui "'Y
n-- f cu ding&Co nfo meat
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090109 Application Number. A20090109
Tax Map No: 523400-296-013-0001-056-000-0000
Permission is hereby granted to: ROBERT &DIANA MARTIN
For progeny located at: 151 MONTRAY 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: ROBERT & DIANA MARTIN
151 MONTRAY Rd Septic Alteration Residential
QUEENSBURY, NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2009-109
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,April 16, 2010
(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 Town of Queensbury, Thursday, April 16, 2009
/r
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY ;
TAX MAP NO. PERMIT No.0 PERMIT FEE 0c)
APPROVALS: ZONING TOWN CLERK ;
-----------------
--------------------
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: `;��e/L/ f}1Q j/,7iJ INSTALLER:
ADDRESS: RJ N,409y #Q'D ADDRESS: _
n L
PHONE NOS. 72 QoSZ /�PHONE NOS. l
LOCATION OF INSTALLATION: 44&ic
YEAR BUILT NO.OF RESIDENCE INFORMATION:
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINgF�R
INSTALLED N0
1981 1991 X 130 gallon per bedroom =
SPA OR HOT TUB
1992•present X 110 gallon per bedroom = INSTALLED? M'o
PARCEL INFORMATION: /
✓ TOPOGRAPHY: Flat rolling ✓ Steep slope %Slope
✓ SOIL NATURE: Sand -Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCMMPERVIOUS MATERIAL: At wh depth?
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is per minute per inch.
(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).
Cxt s;iN 6
TANK SIZE: 1040 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
..SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? I Size? Z
1jr Ulf g6�1
❑ ALTERNATIVE SYSTEM Bed or other type? P tsmri—a..
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
Nf)TI= At eann cveT���
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: q11
Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: -I.LA 1
NAME: M v �. l�,) PERMIT NO.: 0 l
LOCATION: ! TZl INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam Clay
Type of Water: Municipal Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y I N Partial
End Ca
In Outlet Pipes&Baffles Y N �
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft. ��
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
DFrontRear Left Side Right Side � �
Middle Fron Middle Rear
m s:
Approved
_Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
-� - "I have seen or observed, or believe I saw evidence of,
all oblects such as houses, wells, trees, fences, etc.,
/ 4 , , on this document. I also represent that I have
Pe Ona ly measured a istance et f:,rth on the diagram.
SIGNATURC DATE
C .���
a �
- tz
4
- 3