2008-616 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE (31.'rc COMPLIANCE
r
Permit Number. P20080616 Date Issued: Friday, November 21, 2008
This is to certify that work requested to be done as shown by Permit Number P20080616
has been completed.
Tax Map Number. 523400-302-009-0001-02 1-000-0000
Location: 5A REGINALD Dr
Owner. JAMES & JOAN LUDWIG
Applicant: JAMES & JOAN LUDWIG
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, 0/v(
Variance, or other issues and conditions as a result of approvals by the Director of Building WCode Niforcernent
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: P20080616 Application Number. A20080616
Tax Map No: 523400-302-009-0001-02 1-000-0000
Permission is hereby granted to: JAMES &JOAN LUDWIG
For property located at: 5A REGMALD 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: JAMES &JOAN LUDWIG
610 HOLLYWOOD Ave Septic Alteration Residential
HO-HO-KUS,NJ 07423 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans &Specifications
2008-616
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,November 18, 2009
(If a longer period is required,an application loran extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the ToMmvf Queens ury, Tuesday,November 18, 2008
SIGNED BY for the Town of Queensbury.
Director of Building Co nforcement
c7 _/_2 OFFICE USE ONLY...____
TAX MAP NO. PERMIT NO. ERMIT F
APPROVALS: ZONING TOWN CLERK Al , ra r
...................
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.
OWNER: M r 6f INSTALLER: I r
ADDRESS: ADDRESS: t
PHONE NOS. PHONE NOS. Z�C
LOCATION OF INSTALLATION: c V
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATI = = 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? 141 1
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is minutes per inch [MPI]
(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: 1 —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 ABSORPTION FIELD (WITH NO. 2 STONE) Total lengtA50 ft. Each trench �� X (]
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ! i'
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size?_I_A 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 ofC
QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury S ary Sewage Disposal Ordinance. codesCcilgueensburv.net
IT OUR WEBSITE FOR MORE INFORMATION
www.gueensburv.net
S ure of Person Responsible Date
{ T07vn of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
Septic Inspection Report
Office No. (518) 761-8256 Date Ins q�request received:
Queensbury Building &Code Enforcement Arrive: ." am/pm p rt: am/pm
742 Bay Rd., Queensbu , NY 12804 Ins s Initials:
NAME: ,l PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil TyM Loam/ Clay
Type of Water: Ounicipa / Well Water
Waterlin ration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length Zo ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone -71
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box f L
Distribution Box to Field Pit <'
Opening Sealed: N
End 1 ap Y N
Inlet/Outlet/Pipes &Baffles Y N
tion Separations
Foundation to tank ft.
Foundation to absor " n ft.
Separation 9F Pi ft.
Conforms as per Plot Plan Y` N / � G
Engineer Re rt�nd As-Built _N 'Z:�. �7 J
Location of System o
"/etf�-./
Front �R Left Side Right Side Middle Front Middle Rear
S m t
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
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