2007-490 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. P20070490 Date Issued: Tuesday, August 07, 2007
This is to certify that work requested to be done as shown by Permit Number P20070490
has been completed.
Tax Map Number. 523400-296-069-0001-003-000-0000
Location: 3 QUEENS Way
Owner. JOHN H HENEGAN
Applicant: JOHN H HENEGAN
This structure maybe occupied as a:
Septic Alteration Residential
By Oder of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r:
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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070490 Application Number. A20070490
Tax Map No: 523400-296-069-0001-003-000-0000
Permission is hereby granted to: JOHN H HENEGAN
For property located at: 3 QUEENS Way
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: JOHN H HENEGAN
Septic Alteration Residential
3 QUEENS Way
QUEENSBURY,NY 12804 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2007-490
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,August 01, 2008
(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 wn o ee ry' a nesday,August 01, 2007
SIGNED BY for the Town of Queensbury.
Director of Building&Code SEnforcement
........ ... ►.....►..►...►......►.............................►..... ..►.....►..........
OFFICE USE ONLY
425
TAX MAP NO. PERMIT N . '0 ERM1T FEE
APPROVALS: ZONING TOWN CLERK ;
APPLI CATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC TO REVIEW BEFORE IS DANCE OF A VALID
PERMIT. (�
OWNER: e• }(1 If- Zk
INSTALLER: -.= v "!-q Ce
ADDRESS:u e e,Q f (J AU ADDRESS:
PHONE NOS. / r Y
b PHONE NOS. 7 o
LOCATION OF INSTALLATION:
».............»..............»...........................................................� . .............................................................. _ ' RESIDENCE INFORMATION
OF
YEAR BUILT X COMPUTATION_ ( TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDF,)i
1980 or older ")...X. "150 gallon per bedroom Li = 4, I INSTALLED? �
.-1991...... .......................»...»...»...».;...X.........i30 gallon per bedroom
..+................................................I.,......................
» ;..........................................»f.. .............................. ................................................................................ SPA OR HOT TUB
µ1992-present» i .......................................... ..X.........1,1.0.gallon per bedroom l .E....4..........,............,......,...,,....................».,............, INSTALLED? Ill O
».i.. l.. x.. .............................................c.....
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING '� STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND,`/ LOAM C Y OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCKAMPERVIOUS 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 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: ` �0� GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH 13 FT. X FT.
✓ SIZE OF STONE TO BE USED: #_ t DEPTH OR THICKNESS 2 FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY. GAL.
1!1.................„..,...,.,....,.....:.".....,...:.,.,.,.:...:.:.:.:.,...:...,.....,.,.....,...:...,.........:.:...:...,...,.:...,.,...:.:.:...,.:.:.,.,..».,.,,:.,.,,»,.,.:,.,...,..-,.,.,.,.,.,...,.:.,.,.,.,.,.,.,.,.,.....:...,.....:...:».:...,.,.,.,.,...:.,.,.,.,...:...,•,.......:..•............,.........,...,...,.,.......,.,.,.,.......,.,.,,
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN i
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 'I
r..,.,..„.................................:.................:..•,.......................::.:.:.:.:.:..,.:.:.:.:...............,.....,•:.„,.,.;..:.;.:.:.:.:.., ..,..,:...............:..,:.:.........................
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 an all requirements of the Town of QUESTIONS? CALL 781.8256 OR EMAIL
en Sanitary Se Disposal Ordinance. codes@aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
�-�' www.aueensbur_y.net
ature of Person sponsible Date
Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date I s , -fequest received:
Queensbury Building&Code Enforcement Arrive: a rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Ins s Initials•
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK
;/-)
Comments and/or diagram
Soil Type: Sa Loa Clay
T of W unici I Well Water
Waterline separahon-diftance ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepaae Pits: Number
Size: x
Stone Size:
Piping Size T
Building to tank
Tank to Distribution Box a
Distribution Box to Field Pit
Opening Sealed: Y NJ Partial
End Ca
Inlet/Outlet Pipes&Baffles V Y N
Location Se rations
Foundation to tank Ly 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 Sy on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
5Mm Use St
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
-/cio
utj
t
�o
/0 34-rP Z+
�--! ter 66-
1