2008-169 11 TOWN OF QUEENSBURY
4 Road eensb NY 12804-5902 518 761-8201 7 2Bay ,Qu ury, ( )
Community Development- Building &Codes (518) 761-8256
CERTIFICATE CIF COMPLIANCE
Pemnit Number: P20080169 Date Issued: Friday, May 02, 2008
This is to certify that work requested to be done as shown by Permit Number P20080169
has been completed.
Tax Map Number: 523400-301-008-0001-091-000-0000
Location: 53 HELEN Dr
Owner DANIELLE BALLARD
Applicant: DANIELLE BALLARD
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 (---- 44,P 4
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.
TOWN OF QUEENSBURY
`o0111hi
N 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080169 Application Number. A20080169
Tax Map No: 523400-301-008-0001-091-000-0000
Permission is hereby granted to: DANIELLE BALLARD
For property located at: 53 HELEN 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. Type of Construction Value
Owner Address: DANIELLE BALLARD Septic Alteration Residential
53 HELEN Dr Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-169
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 02, 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 own Que bu , F da May 02,2008
SIGNED BY
for the Town of Queensbury.
Director of Building&Code Enforcement
f V -P. - -,
/ ti OFFICE USE ONLY ��: �� f 4 ..
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TAX MAP NO. _ PERMIT NO. �� -FF' PERMIT F ���� _.: 4 • ,.'` { �U4 " i
APPROVALS: ZONING TOWN CLERK ' 1 :
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t ►� ui- 5t EENSBURY
Blfil�f��GC�[�ES
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. ((c
// /OWNER: U itrlG / a, (f4/`v INSTALLER: --1--! /ll I: /C,(>c .
ADDRESS: Xi✓ g (c (((& df ADDRESS: WC21 644_ c r-/.t_(i✓'rG",(f
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PHONE NOS. �3 e ( � D
r PHONE NOS. 7 2r- (9
Y.
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older Y X 150 gallon per bedroom = (0 0 INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
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? 4,Ait'
✓ 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: fie/d1j 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: i riv /
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length256 ft. Each trench_ / X )4
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
O HOLDING TANK SYSTEM Total required capacity? A141/
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
failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury nitary Sewage Disposal Ordinance. codes@aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.Queensburv.net
Si ature of Person Responsible Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
r" tic Insp ton Rep° w- A°P : * I ,4',
Sep .,•nr-. fir .•. •
Date Ins*2, * r: ' a_ 1 �nn�
Arrive.'
Init"t" • i
office No.(518)76143256
6I-&5C.o e Enfo nt Insp or's .0R, if NO.:
Q ensbury Build nsb�►rY NY i2 • MCI.
ON.
742 BM ad"t4 �f '1� I
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NAME,
RECNEC m
LO��ON: ---""
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Willi IIII III ''''
soil , •: Sand l Ulliii11111111
-T .- of Water: 4 ynia;_
Waterline se.-ration ,►stance
Weil separation distaff ' .,�
Other wails: MiPki-Okk. i 2
phso ... Field: Total len• a
Le • of each trench j.• of trenches riiilli"
Size of Stone ���
See...- Pits: Number
Size:
Stone Size:
Piping Size T pe
Building to tank Eyt.1 IT t Or
Tank to Distribution Box >r.\‘‘ lj )iz„%j.S
Distribution Box t " Id/ P" Li t' 1 cf.,.)C
Opening Seal . Y artial
End Cap \/F
Inlet/Outlet Pipes&Baffles Y N
Location/Separations
Foundation to tank
Foundation to absorption _ Z_s) ft.
Separation of Pits —,�ft.
Conforms as per Plot Plan �/Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Left Side Ri ht Side
Middle Front Middle Rear
Sem U s:
Approved
Partial Approved and needs to be re-inspected, please cahg&Codes
Disapproved Ofke
\ N__‘
Last revised 021006 t r
Last revised 1/6/05
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