2008-357 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
4z Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080357 Date Issued: Friday, July 11, 2008
This is to certify that work requested to be done as shown by Permit Number P20080357
has been completed.
Tax Map Number. 523400-301-017-0001-057-000-0000
Location: 16 JOHN St
Owner. DEBRA SOTTOLANO
Applicant: DEBRA SOTTOLANO
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, �Lv
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code L nforcement
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: P20080357 Application Number. A20080357
Tax Map No: 523400-301-017-0001-057-000-0000
Permission is hereby granted to: DEBRA SOTTOLANO
For property located at: 16 JOHN St
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: DEBRA SOTTOLANO
16 JOHN St Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-357
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,July 03, 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 biay,July 03, 2008
SIGNED BY % � for the Town of Queensbury.
Director of Building&Code Enforcement
Ir.`_--._.____._r_.._r__.OFFlCE USE ONLY____r__._._ ___._r_ � %_ _. r_____1
f—�
TAX MAP NO. PERMIT NO. �/�'- RMfT F E ,
APPROVALS: ZONING TOWN CLERK
�Y
_.__,.____.-____ _ ,.r_r_-_._.__rr .i____ r......._r_...r..
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE-OF AVAUP..,,
PERMIT.
OWNER: i`'' �` " INSTALLER:
ADDRESS: J O� ") S ADDRESS:
PHONE NOS._ �t _dc PHONE NOS.
LOCATION OF INSTALLATION: 14ete
II...............................................
.................. ...... ............................................. ...............;...........;...................................:............ .....: RESIDENCE INFORMATION.
NO.OF X............................... .......... ........... ....................
YEAR BUILT ON. OW i BEDROOMS iGARBAGE�. ...............................;..........................................................................;..........:.............................
1980 or older X 150 gallon per bedroom = INSTALLED RIN Ef��
i iV
................................................d......,...................................................i.........................................................................l...........i...................•.�.....................
.................
` 1981 -1991 i ' X i 130 gallon per bedroom i = SPA OR HOT TUB
.......... ....................................j..............................................;...........;............................................................I......... ..... ...................................................................
i " INSTALLED?
1992-present i X 110 gallon per bedroom _ ;
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 1S FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE 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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK: GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH -- FT. X r` FT.
✓ SIZE OF STONE TO BE USED: # "/DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: 3 f X _0
✓ ALTERNATIVE SYSTEM: 6_067 J LENGTH AND/OR SIZE �
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY. GAL.
::..:......................:... ............:.....:..:..:...:............................ .....................................:...:.........................:................................
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 Sanitary Sewage Disposal Ordinance. codes@ciueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
wwwaueensburv.net
Slgnatur of P son Responsible !Date
a',:. Town of Queensbury ■ Community Development Office 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ion quest received:
Queensbury Building &Code Enforcement Arrive: m/p cpart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: o -400 PERMIT NO.:
LOCATION: INSPECT ON: O
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam/ Clay
Tpe of Water: Municipal/ Well Water
Waterline separation distance ft. d r`— F-1
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 Cap Y 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:
Front R r Left Side Right Side Middle Front Middle Rear
S m 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-01.1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
10 ,12- �or5
Septic Inspection Report
Office No. (518) 761-8256 Date Inspeeti � request received:
Queensbury Building &Code Enforcement Arrive:, am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's I 'tials: _
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Ty Loam / Clay
Type of Water: unici I Well Water
Waterlin se ration distance ft.
Well separation distance
Other wells: ft. -
Well Casing Length 50' + - Y N N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches A.
Size of Stone t JCS,
Seepage Pits: Number
Size: x
Stone Size:
Piping ize T
Building to tank 1�Tt
Tank to Distribution Box 4 µ ��
Distribution Box to Field Pit it
Opening Sealed: N
End Ca N
Inlet/Outlet Pipes &Baffles Y N
Location/ Separations
Foundation to tank U 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 Syste n Property:
Front ear Left Side Right Side Middle Front Middle Rear
System Use t
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
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