2009-528 �- TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building& Codes (518) 761-8256
C Ex"Viv I F I CAILE CIF COMPLIANCE
Permit Number: P20090528 Date Issued: Tuesday, November 17, 2009
This is to certify that work requested to be done as shown by Permit Number P20090528
has been completed.
Tax Map Number: 523400-295-014-0002-066-000-0000
Location: 40 MT. VIEW Ln
Owner: WILLIAM G ROE JR
Applicant: WILLIAM G ROE JR
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,
Variance,or other issues and conditions as a result of approvals by the Director ui ing&code doorcern nt
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: P20090528 Application Number. A20090528
Tax Map No: 523400-295-014-0002-066-000-0000
Permission is hereby granted to: WILLIAM G ROE JR
For property located at: 40 MT. VIEW Ln
in the Town of Queens bury,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: WILLIAM G ROE JR
40 MT. VIEW Ln Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
ASHLEYSNELL
692-7058
191 BULSON Rd
GREENWICH,NY 12834-0000
Plans&Specifications
2009-528
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, October 26, 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 ens ry; ay, October 26, 2009
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY ' + I �
/"► V
TAX MAP NO. PERMIT NO. X PERMIT FEE' ` + ;
APPROVALS: ZONING cvt TOWN CLERK ; OCT 2 G 2009
+ -x V + +
+
._...------------.------______------------------- ---1
O F ctulwENsBuRv
APPLICATION FOR SEPTIC DISPOSAL SYSTEM �1G& CODES
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. ,1
OWNER: i
1►4� 7 I � O� � J �� ` INSTALLER: A•5 N L L—
ADDRESS: 40 ADDRESS: ` I G �1 ` 3
PHONE NOS. Z q 3 " 919 I( PHONE NOS, C9 ! ,9 1 7 Q S
LOCATION OF INSTALLATION: t�
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = ,4��'L+ L �,� INSTALLED?
1981 -1991 X 130 gallon per bedroom = S'D . 4 - SPA OR HOT TUB,),,
1992-present X 110 gallon per bedroom = �� L' INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling 7` Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth? z
✓ 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: % ®® Q 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.
�P I� p1-18 ��js�-��� s � � -7�q,yk
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
-06SEEPAGE 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?
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.
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req st e i ed: LI
Queensbury Building &Code Enforcement Arrive: -\ l art: l0-
742 Bay Rd., Queensbury, NY 12804 Inspector's In
NAME: U� P IT NO.:
LOCATION: �a MI:' V, N ECT ON:
RECHECK:
Comments and/or diagram
Soil T / Clay
Type of Wa . unici I ell Water
e ara ion is ante ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - L 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 Type
Building to tank 1�
Tank t�
D' Pit F
-
Opening Sea ed: 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:
Fro ar l�ft_Side Right Side Middle Fron Middle Rear
yj em U e us
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc