2009-143 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090143 Application Number. A20090143
Tax Map No: 523400-308-015-0001-043-000-0000
Permission is hereby granted to: RAYMOND W BUTLER
For property located at: 416 CORINTH 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: RAYMOND W BUTLER
449 CORINTH Rd Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2009-143
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,April 24, 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 of Qu b ,April 24, 2009
F
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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. P20090143 Date Issued: Monday, November 29, 2010
This is to certify that work requested to be done as shown by Permit Number P20090143
has been completed.
Tax Map Number. 523400-308-015-0001-043-000-0000
Location: 416 CORINTH Rd
Owner. RAYMOND W BUTLER
Applicant: RAYMOND W BUTLER
This structure maybe occupied as a:
Septic Alteration Residential
By Omer of Town Board
TOWN OF QUEENSBURY
7f
Issuance of this Certificate of Compliance DOES NOT relieve the
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 Enfor ement
Planning Board or Zoning Board of Appeals.
OFFICE USE ONLY V
TAX MAP NO. PERMIT NO. PERMIT FEE
J APR. , , 1!
APPROVALS: ZONING TOWN CLERK 2 4 .200
U G& CODESR�I"
APPLICATION FOR SEPTIC DISPOSAL SYSTEM -
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISS PERMIT,
UANCE OF A VALID
OWNER: NCAJ UIl INS
TALLER:
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ADDRESS: Y [�} f O/ ADDRESS:
PHONE NOS. PHONE NOS. —7 J t J
LOCATION OF INSTALLATION: q `�
YEAR BUILT NO.OF X COMPUTATION= RESIDENCE INFORMATION:
BEDROOMS = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = INSTALLED?GARBAGE GRINDER
1981 -1991 X 130 gallon per bedroom
1992-present X 110 gallon per bedromo _ SPA OR HOT TUB
INSTALLED?
PARCEL INFORMATION:
TOPOGRAPHY: Flat rolling Ul Steep
� slope_ %Slope
✓ SOIL NATURE: Sand ;] Loam
Clay Other
✓ GROUNDWATER: At what depth? t l
BEDROCK/IMPERVIOUS MATERIAL: At at depth?
✓ DOMESTIC WATER SUPLY: Municip
al Well (If well: Water supply from any septic
IV
� system absorption is ft.)
minutes per inch [MPI]
✓ PERCOLATION TEST: Rate is
(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 engineeror architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: 100r,' GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the se ti
each garbage grinder, spa or whirlpool tub. p c tank for
SYS EM TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total len th _
9 ft. Each trench X---J-_=
❑ 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?
i 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, .
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. codes clueensbury net
l� c� VISIT OUR WEBSITE FOR MORE INFORMATION
1. ��� ! www.aueensbury net
Sign a of a on Responsible Date
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbu
ry, NY 12804
B 5-LGL 6/06
V
Septic Inspection Report
Office No. (518)761-8256 Date In rrrrNO.:
Queensbury Building&Code Enforcement Arrive: rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's In NAME: vP A
LOCATION: AT INSPECT ON:
RECHECK:
Comment, and/or diagram
Soil T m a
Type of W nig ell Water
Waterline seDar&kwedrstance ft•
Well separation distance ft.
Other wells: ft.
Absorption Field: Total lengLh ft.
Length of each trench
Depth of trenches ft•
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank L
Tank to Distribution Box
Distribution Box d Pit 14411
Opening Sea artial
End Ca
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank t ►ti ft•
Foundation to absorption ft.
Separation of Pits Z ft.
Conforms as Der PI Ian N
En ineer Report a0d As-Built Y N
Location of Sy
Front ear eft Si Right Side
Middle die Rear
-System t 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
E C E 0 W E
APR ? 4 2009
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