2007-660 4
V 4:
TOWN OF QUEENSBURY
(� 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
10 Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20070660 Date Issued: Tuesday, December 11, 2007
This is to certify that work requested to be done as shown by Permit Number P20070660
has been completed.
0 Tax Map Number. 523400-239-008-0001-038-000-0000
Ix
o- Location: 17 CAYUGA Dr
Owner. JANET KRISTEL
Applicant: JANET KRISTEL
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 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: P20070660 Application Number. A20070660
Tax Map No: 523400-239-008-0001-038-000-0000
Permission is hereby granted to: JANET KRISTEL
For properly located at: 17 CAYUGA 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: JANET KRISTEL
212 MOHAWK Trl Septic Alteration Residential
SCHENECTADY,NY 12309-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
PHILLIP BARR
340 QUEENSBURY Ave
QUEENSBURY,NY 12804-0000
Plans &Specifications
2007-660
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, October 29,2008
(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 T Quee ry; Mdo ay, October 29,2007
SIGNED BY for the Town of Queensbury.
Director of Building Code nforcement
For an EPA homeowner's guide: http://www.epa.gov/nodes/pubs/homeowner guide long customize.pdt
_____-__-_______________________________________ ____________ 0
USE ONLY
TAX MAP NO. PERMIT NO. ERMIT F , y.
' + ,
APPROVALS: ZONING TOWN CLERK V l `' OCT ? 4 2007 O4 P
s
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PEn-. r x
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. �/,�
OWNER: aea2rxy INSTALLER: &UP 13-t rr
ADDRESS: /7 LC'�f l L 4 B' p/1/ylT ADDRESS:3YIOOue?e7 (-,, au e
PHONE NOS. ,7`1[� �� 7 D ?-OO n PHONE NOS. �ZS- P `( - (9 d38�
LOCATION OF INSTALLATION: 17 C4 f;L.,�� 00a i✓E O/e yer,014/C--
RESIDENCE
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
BEDROOMS
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER,,,(J
1981 -1991 X 130 gallon per bedroom = INSTALLED?
1992-present X 110 gallon per bedroom = SPA OR HOT TUB P�
INSTALLED.
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT AT DEPTH? rJjj& BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WAT SUPLY: l9�SdaGt lam IVotle l Sv /;G
MUNICIPAL WELL (If well:water supply from any septic syste a rption is: ft)
✓ PERCOLATION TEST: RATE IS N tA' 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 archite 4unless installed in a P nning Board approved subdivision).
TANK SIZE: If _GALLON (MIN. 91ZE IS 1,000 GAL.)Add 250 gallons the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
OUSORPTION
M TYPE:
FIELD (WITH NO. 2 STONE) Total length trench X
SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed 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 ?:CALL 761-8256 OR EMAIL
to abide by these and all requirements of the Town of Queensbury codesueensbury.netSanita age Disposal Ordina (:QUESTIONS
IT OUR WEBSIOR MORE INFORMATION
www. ensbury.net
' nature of on Responsible Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm part: (1 'its, am/pm
742 Bay Rd., Queensbury, NY 128804! Inspector's Initials: x `
NAME: _ �/✓ / PERMIT NO.: Im
LOCATION: c INSPECT ON: !
RECHECK:
Comments and/or diiagram
Soil T : Sand rr Cla
Type of Water: ell Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total length ft. OIL,
jength of each trench ft.
Depth of trenches ft.
Size of Stone
Seepaqe Pits: Number
Size: x
Stone Size:
Piping Size Typt
Building to tank _ 64 1,0
Tank to Distribution Box
Distribution Box tp4Aeld Pit `v1
Openinq Sealed:!Y g N Partial
End Ca
In Outlet Pipes&Baffles N
Location I Se rations
Foundation to tank �
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built N +�`
Location of System on Property:
Front (e)arLeft Side Right Side
Middle Front Middle Rear
sygcm
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
.rt Community Developrraent O ice
Town of Queensbury - 742 Bay .Rd.
Q"ueensbury, New York •12804 PLOT PLAN
ShgW all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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