2008-641 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Pernut Number. P20080641 Date Issued: Thursday, August 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20080641
has been completed.
Tax Map Number. 523400-308-019-0001-023-000-0000
Location: 18 DIVISION Rd
Owner. ALLEN BUD CHATTERTON
Applicant: ALLEN BUD CHATTERTON
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Boat
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&Co a Enfo ement
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: P20080641 Application Number. A20080641
Tax Map No: 523400-308-019-0001-023-000-0000
Permission is hereby granted to: ALLEN BUD CHATTERTON
For property located at: 18 DIVISION Rd
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: ALLEN BUD CHATTERTON
Septic Alteration Residential
VIVIAN DE LONG
18 DIVISION Rd Total value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans &Specifications
2008-641
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,December 05, 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 row]no�;u ,: j December 05,2008
SIGNED BY `` for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY '
TAX MAP NO.
" PERMIT NO. '`r __.. PERMIT FEE j rf C "t 2008
0
, ,
o APPROVALS: ZONING TOWN CLERK
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: ` ' ? INSTALLER: : st-
ADDRESS: 1( �Jg �/# �Z1-"' � ADDRESS: C���". ' 6 :a ✓ rz f� K
PHONE NOS. 4 - (.l PHONE NOS.
LOCATION OF INSTALLATION: /O dJCU�1(J
NO.OF RESIDENCE INFORMATION:
BEDROOMS
YEAR BUILT 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 K"' Well (If well: Water supply from septic
system absorption is from
✓ 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: Q ' GALLON (1,41N. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
4 each garbage grinder, spa or whirlpool tub.
6 �'76
SYSTEM TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total lengthy ft. Each trench X X �c
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Brad 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 of QUESTIONS? CALL 761.8256 OR EMAIL
Queensbury Sa y Sewage Disposal Ordinance. codesftueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
/��'A- r 4Z�z" www.aueensburv.net
Sig ure of erson Resp sib a ate
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
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Septic Inspection Report
Office No. (518) 761-8256 Date Ins coon quest received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., QueenC11a
sbury, NY 12804 Inspector's Initials: AC
ANAME: lk"—,?OLL h PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK: -
Comments and/or diagram
Soil Type: oam/ Clay
Type of Water: uni i al Well Water
Waterli ration distance ft.
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
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping SiA Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit I I
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes &Baffles Y N
Location Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits z ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear °t Left S' a Right Side Middle Front Middle Rear
System Use Status:
ti 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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