2007-505 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: P20070505 Date Issued: Thursday, August 09, 2007
This is to certify that work requested to be done as shown by Permit Number P20070505
has been completed.
Tax Map Number: 523400-295-011-0001-025-000-0000
Location: 60 SARA-JEN Dr
Owner: JOHN & JOAN FARON
Applicant: JOHN & JOAN FARON
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 uilding Co nt
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbwy,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256,
BUILDING PERMIT
Permit Number: P20070505 Application Number. A20070505
Tax Map No: 523400-295-011-0001-025-000-0000
Permission is hereby granted to: JOHN &JOAN FARON
For property located at: 60 SARA-JEN 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. Tyne of Construction Value
Owner Address: JOHN &JOAN FARON
Septic Alteration Residential
60 SARA-JEN Dr
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2007-505
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,August 07,2008
(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 To of ensb , % s gust 07, 2007
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
/_..r.r....r.._._r....rr.._...r_r.._rr....r...__ ...r r r.r r_....._ . _._...rr..__.r.._._
�Jr OFFICE USE ONLY ;
e f "/ _Gam—p�j 57 I I
nAX MAP N0. PERMIT NOVZ- PERMIT FEE `+
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.
lot
OWNER: dA I / INSTALLER:
ft
ADDRESS: =e o L r• Will Al ADDRESS:
PHONE NOS. PHONE NOS.
LOCATION OF INSTALLATION: D S
.....»._.....................»......................................w.......................i............1................................................................................................................................................................
. RESIDENCE INFORMATION:
NO.OF ' TOTAL DAILY FLOW
YEAR BUILT I BEDROOMS X ! COMPUTATION= = i
.......•........................................».............»...................»......t.............................................................. 1. ......,......I GARBAGE GR{NDF,R
1980 or older s X 1
I ': 50 gallon per bedroom I = i INSTALLED?
........................................................;.......................................................•............................................».........................................................
..........1981 -1991 ........1 € X 1 130 gallon per bedroom _
...........................................................................................r..........i.................................................................... .•.. SPA OR HOT TU��
... ,!i _
1992..present ! X i 110 gallon per bedroom I = I INSTALLED?-
........
...... ...... ........
4
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING_ STEEP SLOPE %SLOPE
✓ SOIL NATURE:SAND LOAM CLAD_ OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAIL X WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE 1S 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 TNKyt 24'0 GALLON (MIN. SIZE IS 1,0C1 GAL.) TILE FIELD: EACH;TRENCH Q_FT.
✓ TOTAL SYSTEM LENGTH: a2 V 0 FT. SEEPAGE PIT(S): HOW MANY?.
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # .2 �/DEPTH OR THICKNESS_ FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH ANDIOR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
GALLONS.ITOTAL CAPACITY. GAL.
:.:...:.:.........:...........................:...:.:.:.....:.:.:.:.:.:.........................:.....:.:.:.....:::...:...........,.:.......:.:...... ...:...:.:.:.:.;...:.;.:.:.:...:.:.:.:.:.a.,.:.:.:...:.:.:.:.:.............................:.:.:.............:............................................................
:.:...:.:...:.:.r
iI 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. code-s@aueonsb!jrv.net
OUR WESSITE FOR MORE INFORMATION
www.ciueenabury.net
SIgnat f rson Responsible Date
QTown of Queensbury ■ Community Development Office - 742 Bay Road, Queensbury, NY 12804
s
Septic Inspection Report
Office No. (518) 761-8256 Date Ins n Tuest received:
Queensbury Building&Code Enforcement Arrive: �� am/pm_ �Deart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: �i�a2 °'LJ a-7 j
PERMIT NO.:
LOCATION: INSPECT ON: eF 0-
RECHECK:
Comments and/or diagram
Soil T Sa la
T of Wa r: units / Well Water
Waterline se on distance ft.
Well separation di nce ft.
Other wells: ,
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 T
Building to tan
Tank to DistribU ' x n 5 ooe 3
Distribution Bo to F Id Pit M o,
Opening Seal N Partial
End Ca
In Outlet Pipes&Baffles Y N
Location Se rations
Foundation to tank ft.
Foundation to abso 'on 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 ear Left Side Right Side
Middle Front dle Rear
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
Septic Inspection Report
Office No. (518) 761-8256 Date In9nWals:
request
Queensbury Building&Code Enforcement Arrive: am/ part am/pm
742 Bay Rd., Queensbury, NY 12804 Ins
NAME: U � � PERMIT NO.: —
LOCATION: C� INSPECT ON: 977
RECHECK: l �
Comments and/or diagram
Sol!Type: Sand Loam Clay
Type of Water: Municipal Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total lengpift.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepw Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y I N Partial
End Ca
In Outlet Pipes&Baffles Y N
Location Separations d�
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N v
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Stat s•
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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