2009-224 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090224 Application Number. A20090224
Tax Map No: 523400-309-005-0001-057-000-0000
Permission is hereby granted to: STEVEN LELAND
For property located at: 4 OAK TREE Cir
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: STEVEN LELAND
4 OAK TREE Cir Septic Alteration Residential
QUEENSBURY, NY 12804-0000 Total value
Contractor or Builders Name/ Address Electrical Inspection Agency
Plans &Specifications
2009-224
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, May 28, 2010
(If a longer period is requited,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 Q ry; T sda May 28,2009
SIGNED BY ueens for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(zt Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20090224 Date Issued: Monday, June 01, 2009
This is to certify that work requested to be done as shown by Permit Number P20090224
has been completed.
Tax Map Number. 523400-309-005-0001-057-000-0000
Location: 4 OAK TREE Cir
Owner. STEVEN LELAND
Applicant: STEVEN LELAND
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
property owner of the responsibility for compliance with Site Plan, )av'7-��V 1
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.
%......................"'" OFFICE USE ONLY ....___...____-- � I
--�-�-.�-a-�-�-
PERMIT NO. �=� ► PERMIT FEE
TAX MAP NO. 1OU9
APPROVALS: ZONING TOWN CLERK
,
TOWN OF QUEENSBURY,
____________ _-___--
_____________ -r3urtvllvG 'cbtSES
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
OWNER: _ INSTALLER: a'q
ADDRESS: �r-! �� is L(t C�� ADDRESS: IVS
PHONE NOS. ! `' ) 1 PHONE NOS.._ t q7 —T Z`ID
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OFBEDROOMS X COMPUTATION= = TOTAL DAILY FLOW GARBAGE GRINDE�
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rollin �- steepslope %Slope
✓ SOIL NATURE: Sand y Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS 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 professiol�gigeer or architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: `7 NNGAALLON (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:
❑ A ORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? '7� Size? X10,
-
❑ 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
is APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
Septic Inspection Report
Office No. (518) 761-8256 Date InspectioVPECT
eiv
Queensbury Building &Code Enforcement Arrive: part: a
742 Bay Rd., Queennsbury, NY 12804 Inspector's Init `"
NAME: .:
LOCATION: : -Q7
RECHECK:
Comments and/or diagram
Soil T am/ Clay
Type of Wate ."Muni ' ater
Water I ration distance
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 Zr
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Ceit 'I 1
Opening Seal N
End Ca Y N
Inlet/Outlet Pipes&Baffles N
Location/ Separations
Foundation to tank
Foundation to absorption A ft. V-1 I '�
Separation of Pits ft.
Conforms as per PI an N
Engineer Report a As-Bui Y N
Location of System on Property:
Front Re eft Si Right Side Middle Front Middle Rear
System e s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
Mp
�Z_
zr
q pq
T
a
Z
1
E
i
R