2009-140 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090140 Application Number. A20090140
Tax Map No: 523400-308-005-0001-077-013-0000
Permission is hereby granted to: T. STEPHEN&KAREN FIELDING
For property located at: 8 LYDIA 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. Tyne of Construction Value
Owner Address: T. STEPHEN&KAREN FIELDING
8 LYDIA Ln Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2009-140
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,April 22, 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 To eens7 ,kd esday, April 22, 2009
SIGNED BY '' for the Town of Queensbury.
Co Director of Building de nforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CE RT I F I CAT E OF COMPLIANCE
Permit Number. P20090140 Date Issued: Wednesday, April 29, 2009
This is to certify that work requested to be done as shown by Permit Number P20090140
has been completed.
Tax Map Number. 523400-308-005-0001-077-013-0000
Location: 8 LYDIA Ln
Owner. T. STEPHEN & KAREN FIELDING
Applicant: T. STEPHEN & KAREN FIELDING
This structure maybe occupied as a:
Septic Alteration Residential
By Omer of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, W. ..
Variance, or other issues and conditions as a result of approvals by the Director of Building Code orcement
Planning Board or Zoning Board of Appeals.
�_ �_.___--'FFICE USE ONLY
� - -_-__-_-___ - _ / �-�- _ --__-_'
. / �) n
TAX MAP NO. ERMIT NO. V " I.�ERMIT FE
APPROVALS: ZONING ' ' ap'�
,
TOWN CLERK 0
---- --
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT; CODED
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: CS Tt'C��I e�J /E L ,��.✓� INSTALLER:JIR I'/ ✓?,trz yW Cti
ADDRESS:-8 L y o f.¢ /—/v L /70 y 6 F
ADDRESS:
PHONE NOS. / / 1 PHONE NOS. / 9(0
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF X COMPUTATIO = RESIDENCE INFORMATION:
BEDROOMS = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
1981 -1991 INSTALLED? Al
X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = ` SPA OR HOT TUB
INSTALLED1
PARCEL INFORMATION: /
✓ TOPOGRAPHY: Flat rolling v Steepslo e
P %Slope
✓ SOIL NATURE: Sand_ Loam
Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOU') MATERIAL: At wh t 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).
TANK SIZE: �4 ddJ 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:
12�-ABSORPTION FIELD (WITH NO. 2 STONE) Total length � J s
g ft. Each trench � X ;2
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ 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 abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. coaeseaueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
�? www.gueensbury.net
ature of Person Responsible Date /
-_ Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
.z;
Septic Inspection Report
Office No. (518) 761-8256 Date Inspe i ,request received:
Queensbury Building &Code Enforcement Arrive: ' am/ rr��,,flepart: am/pm
742 Bay Rd., Queensbury, Y 12804 Inspect is Initials: �Y
NAME: r; ' PERMIT NO.:
LOCATION: — -
INSPECT ON:
RECHECK. tj `
Comments and/or diagram
Soil T Loam/ Clay
Type of Water: MuniciRA/Well Water
Waterli ration distance ft.
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
Size: x
Stone Size:
Piping Si e T e
Building to tank / „-17 f
Tank to Distribution Box
Distribution Box to Field/ Pit t...
Opening Sealed: N
End Cap _ _N
Inlet/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:
Front PA
Left Side Right Side Middle Front Middle Rear
s m
oved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
I have seen or observed, or believe i saw evidence of,
C IE !aal1 ch ects such as houses, wells,trees,fences, etc.,
f cF tiEis document. l also represent that t have
�pSo Joy iy n<eas e distances set forth on t diagram.'
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