2009-290 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIIA►NCE
Pernut Number. P20090290 Date Issued: Monday, November 29, 2010
This is to certify that work requested to be done as shown by Permit Number P20090290
has been completed.
Tax Map Number. 523400-296-014-0001-07 1-000-0000
Location: 2 APPLE Ln
Owner. RICHARD & KATHLEEN MEATH
Applicant: RICHARD & KATHLEEN MEATH
This structure may be occupied as a:
Septic Alteration Residential
By Omer of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve they �;P
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 EnforcementPlanning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
(2t 742 Bay Road,Queensbwy,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090290 Application Number. A20090290
Tax Map No: 523400-296-014-0001-07 1-000-0000
Permission is hereby granted to: RICHARD &KATHLEEN MEATH
For property located at: 2 APPLE 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: RICHARD & KATHLEEN MEATH
2 APPLE Ln Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans &Specifications
2009-290
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,June 30,2010
(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 o of ury ,/ f sday,June 30,2009
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SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
_ ...........................
OFFICE USE ONLY
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TAX MAP NO. PERMIT NO. ERMIT FEE ; JIJN U 1�a9
APPROVALS: ZONING TOWN CLERKQWN OF Q NSBURY
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ODES
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. k
OWNER:
I '` eU INSTALLER:
ADDRESS:,
ADDRESS: � � �� AD - Y
PHONE NOS. PHONE NOS. "� u kA
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LOCATION OF INSTALLATION:
RESIDENCE INFORMATION;
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older ix
150 gallon per bedroom = INSTALLED?
1981 .1991 130 gallon per bedroom = SPA OR HOT TUB
1992.present 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope (�
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what 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. � �� iGAC.LON (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 �5�) ft. Each trench X
❑ 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. PI FAGI= MC%n=1111 ' '^-
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: , am/pm �part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspecto 1 s nitials: CC-�—
NAME: V• PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK: `
Comments and/or diagram
Soil Type. Loam/ Clay
Type of Water: ouniciW Well Water
Waterlin 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 Size e
Building to tank i 5
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: il/ N
End Ca N
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank
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 Property:
Front Rea Left Side Right Side Middle Front Middle Rear
Sy-sLem Use
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-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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