2008-227 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20080227 Date Issued: Monday, May 19, 2008
This is to certify that work requested to be done as shown by Permit Number P20080227
has been completed.
Tax Map Number: 523400-308-016-0002-007-000-0000
Location: 21 MERRITT Rd
Owner: MATTHEW LEAHY
Applicant: MATTHEW LEAHY
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 of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
�f � OFFICE USE ONLY
'
RE
00 TAX MAP NO. PERMIT NO. PERMIT FEE " ;; I
APPROVALS: ZONING TOWN CLERK
-------------------------------___------_------------------------ _i i >_ ___________ :.
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PMIUMi � '4G, u �r� . '
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. l
OWNER: C /, INSTALLER:
ADDRESS:_-_ _si l I�f;l ✓ ADDRESS: �� �i�-c / '^-U� fOr
PHONE NOS. G PHONE NOS.
LOCATION OF INSTALLATION: 06 ,
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = 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?
✓ 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: 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:
XABSORPTION FIELD (WITH NO. 2 STONE) Total lengt;a 01 --ft. Each trench X f'
❑ 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. 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 ofCQUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes@aueensburv.net
r / UR WEBSI.g FOR MORE INFORMATION
!J www.gueensbury.net
SI nature of Person Responsible date
'-lTown of Queensbury - Community Development Office■ 742 Bay Road, Queensbury,NY 12804
B 5-LGL 6/06
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r i�ve S
Queensbury Building &Code Enforcement Arrive: a part: a
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia s:
NAME: MIT NO.: or_ [�
LOCATION: - _ NSPECT ON: 7`uzi9
RECHECK: Lj•--pq_qj5—
Comments and/or diagram
Soil T m Clay
Type of Water: un I ell Water 102
Waterli ion distance o ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N _N/A
Absorption Field: Total length ZQO 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 Distributiao Box
Distribution Box WFieWJ Pit 'i
Opening Sealed: N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft.
Conforms as r Plot Plan i N
Engineer Report and As-Built :�V
Y N
Location of System on Property:
Front R Ar Left Side Right Side Middle Front Middle Rear
System Use
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