2008-140 04111111 "''' TOWN OF QUEENSBURY
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742 Ba Road eensbu NY 12804-5902 518 761-8201
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Community Development- Building&Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20080140 Date Issued: Monday, April 21, 2008
This is to certify that work requested to be done as shown by Permit Number P20080140
has been completed.
Tax Map Number. 523400-309-013-0001-046-000-0000
Location: 14 CONNECTICUT Ave
Owner. DEXTER& BARBARA CAMPBELL
Applicant: DEXTER& BARBARA CAMPBELL
This structure may be occupied as a:
Septic Alteration Residential
By Otder 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 of Building&Code nfo ent
Planning Board or Zoning Board of Appeals.
41" TOWN OF QUEENSBURY
Iwo 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080140 Application Number: A20080140
Tax Map No: 523400-309-013-0001-046-000-0000
Permission is hereby granted to: DEXTER&BARBARA CAMPBELL
For property located at: 14 CONNECTICUT Ave
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: DEXTER& BARBARA CAMPBEL
14 CONNECTICUT Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-140
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES:
Tuesday, April 21,2009
(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 To o eens , o ay,April 21,2008
SIGNED BY avgY for the Town of Queens
bury.
ury.
Director of Building&Code Enforcement
,:-::0 t-/-i./ 3 7_46
OFFICE USE Oa
NLY
TAX MAP NO. ERMIT NO. -MERMIT FEE ��
APR 1_ 72008
APPROVALS: ZONING �`-" TOWN CLERK ,
TOWN"OFQUEENS BURY'
APPLICATION FOR SEPTIC DISPOSAL SYSTEM P ILDING.8, CODES
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. /� / g'ECI
OWNER:DI rL- (a. pbe `) INSTALLER: 5iyiA
ADDRESS: ( u,7,R2'' �` C- A
fT ADDRESS4:?3 v i'ht AV
PHONE NOS.6-1 79 3O 7 2-' PHONE NO( 6/ 7,- g 1 K.36
fi
LOCATION OF INSTALLATION: -5:41`'Ir
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRIPER
1980 or older3 X 150 gallon per bedroom = Q INSTALLED? V
1981 -1991 X 130 gallon per bedroom = SPA OR HOT
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION: I
✓ TOPOGRAPHY: Flat rolling * Steep slope %Slope
✓ SOIL NATURE: Sand V 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).
neisr/iv G
TANK SIZE: /OM 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.
SYSTEM TYPE:
r
ABSORPTION FIELD (WITH NO. 2 STONE) Total length 20d ft. Each trench 2' x So
❑ 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
li 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.
05--,...._
PLOT PLAN
SEPTIC SYSTEM
Notice: The following statement must be "stamped" on your plot
plan. This sheet of paper may be used for purposes of
drawing your plot plan. After drawing such plot plan,
please read the statement and sign it . If you choose to
use other .a.er for our slot plan, : r- o ,' ce will stamp
tho .e plans for your signa ure. r W W
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R "I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on Uri' . 1 um rt. I also represent that I have
personall : • i re dis nces set forth on II dia am."
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SIGNATURE nIE
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. Septic Inspection Report
Office No. (518)761-8256 Date Inspectioprequest received:
Queensbury Building&Code Enforcement Arrive: '�. l am/ @.. art: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: I
NAME: . PERMIT NO.: OA .[
LOCATION: / Cov r' 1<c ' AU-C...... INSPECT ON: _ i
RECHECK:
Comments and/or diagram
Soil Type dp. .- Clay
Type of . -r: /Well Water
Waterline separa�'. •istance ft.
Well separation distance ft.
Other wells: ft.
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� Ty
Building to tank --?f j�
Tank to Distribution x t ``Distribution Box Id/ Pit 0.
Opening Sealed. / N/ Partial
End Cap
Inlet/Outlet Pipes&Baffles Y N i
Location/ Separations
Foundation to tank i`'4'ft.
Foundation to absorption ft.
Separation of Pits — Y�ft.
Conforms as per Plot Plan �(' N
Engineer Report and As-Built Y—N
Location of System on Pro►-rty:
Front •ear de Right Side
Middle Front Middle Rear
system t
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05