2009-612 -� TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761.8256
ER.TI F I f%.'.,ATE %F COMPLIANCE
Permit Number, P20090612 Date Issued: Tuesday, January 05, 2010
This is to certify that work requested to be done as shown by Permit Number P20090612
has been completed.
Tax Map Number. 523400-295-019-0001-037-000-0000
Location: 18 LYNNFIELD Dr
Owner. PATRICK & ROBIN CRONIN
Applicant: PATRICK &ROBIN CRONIN
This structure maybe occupied as a;
Septic Alteration Residential
By Order of Town Board
TOWN Of `f QUEENSBVR.Y
Issuance of this Certificate of Compliance DUES NOT relieve the ,.r
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 Enforcement
Planning Board or Zoning Board of Appeals.
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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090612 Application Number: A20090612
Tax Map No: 523400-295-019-0001-037-000-0000
Permission is hereby granted to: PATRICK& ROBIN CRONIN
For property located at: 18 LYNNFIELD Dr
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: PATRICK&ROBIN CRONIN
18 LYNNFIELD Dr Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2009-612
septic alteration residential
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, December 23, 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 T1"of .ueen �ry;4 ;� `} ay, December 23, 2009
SIGNED BY L �`'i V � `` for the Town of Queensbury.
Director of Building&Code Enforcement
______________ OFFICE USE ONLY-------------------_----_-; ;- --- _--
TAX MAP NO. PERMIT NO. I ERMIT FEE_ 0 ;
0 �
'
o APPROVALS: ZONING TOWN CLERK
r-
------------------------ ------- ------- /--------
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. P4-nvlac::�
(� _ jOWNER: 1(t 1l� //�/ INSTALLER: ��i� Aw Q /
ADDRESS:_ 1 L L//�Ylj / LD 4�� ADDRESS: I ox F
PHONE NOS. / i J� 7 PHONE NOS. 7 9 " — ® F,5 o
LOCATION OF INSTALLATION:
NO.OF RESIDENCE INFORMATION:
BEDROOMS
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRIND
1980 or older X 150 gallon per bedroom = ,j�U INSTALLED? ,)
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB N
1992-present X 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 ell (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 indix,.dual sewage disposal systems must be designed by
a licensed professional en meer or architect (unless installed in a Planning Board approved subdivision).
TANK SIZE: GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whiripool tub.
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
,SEEPAGE PIT(S) (WITH NO. 3 STONE) How many?�_ Size? I `X /�
El ALTERNATIVE SYSTEM Bed or other type?
(w)� 110 2) 2' F J
❑ 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
- -- TOWN OF OUEENSBURY
- -- - BUILDING & COM, EP .
- Reviewed By:
_ AL-
or
Dates l
p -
i
�jw.rved, or believe I saw evidence-of,
sull-i as, poses,-wells,trees,fences, etc- -
- - on this dout e I also represent that t have
easure-d 'stanc t f rtli flQ t, dta ca .
SIGN VT JRE DATE
- I •
_ ._ _ _. _ _.__..__ -_ ____ ._ __._ ___.__ _ _ __._ _ ____.- _... ____ _ _�_ __ _ _ - __... _�_. __ _____,..._ ___...v- _ _ __ ___ _ _ _ _._ -_
_. ,1 I _._
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Septic Inspection Report
Office No. (518) 761-8256 Date Insp cti request r eived:
Queensbury Building &Code Enforcement Arrive: amp Depart: am/pm
742 Bay Rd., Queen ury, NY 12804 Inspectot' Initials: �}
NAME: h I PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
�1 Comments and/or diagram
Soil T Loam Clay
Type of Water: 1/ Well Water
Waterll a se ation 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 Type
Building to tank
Tank to Distribution Box -`
Distribution Box to Field Pit
Opening Sealed: Y N
End Ca N
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of Syst on Property:
FrontRear Left Side Right Side Middle Front Middle Rear
a..
System Use Status:
_ i 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