2007-741 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CE RTIFICATE OF COMPLIANCE
Permit Number. P20070741 Date Issued: Thursday, December 06, 2007
This is to certify that work requested to be done as shown by Permit Number P20070741
has been completed.
Tax Map Number. 523400-295-014-0002-018-000-0000
Location: 55 MT. VIEW Ln
Owner. KEVEN SMITH
Applicant: KEVEN SMITH
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, �' g
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
(2t 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070741 Application Number. A20070741
Tax Map No: 523400-295-014-0002-018-000-0000
Permission is hereby granted to: KEVEN SMITH
For property located at: 55 MT. VIEW Ln
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: KEVEN SMITH
Septic Alteration Residential
55 MT. VIEW Ln
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY, NY 12804
Plans &Specifications
2007-741
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, December 04,2008
(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 Tovltn Quee�; ty ..
� uoq,a December 04, 2007
SIGNED BY tb, for the Town of Queensbury.
Director of Building&Code Enforcement
/___.__��s_ � /� '� �/ ICE USE ONLY___________________ _ ' %__ _________________.;
TAX MAP NO. PERMIT NO.0 7-7zJ/PERM,T F ,
o APPROVALS: ZONING TOWN CLERK ;
' + 0
------------_---------------___,_.________.____________._' 1___._________________i
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:k7-rf 't /'t / /zj INSTALLER: /!
ADDRESS: ADDRESS:
PHONE NOS. C/� '(� �� PHONE NOS.
LOCATION OF INSTALLATION:
NO.OF
YEAR BUILT X COMPUTATIONS = TOTAL DAILY FLOW RESIDENCE INFORMATION:
BEDROOMS GARBAGE GRINpE
1980 or older X 150 gallon per bedroom = INSTALLED
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUA
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? /T
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?'-�—
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
/ system absorption is ft.)
/✓ PERCOLATION TEST: Rate is ',S per minute 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).
TANK SIZE: �iALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of the septic tank for
ach garbage grinder, spa or whirlpool tub.
SYSTEM TYPE: '
CC �
' ABSORPTION FIELD (WITH NO. 2 STONE) Total length d ft. Each trench X J
❑ 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 to abide by these and all requirements of the Town of QUESTIONS? CALL nsbur - OR EMAIL
Queensbury San'tary Sewage Disposal Ordinance. codes@pueensburv.net
Ab
�L72
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburv.net
Si ature of Person Responsible Date
7- Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury., NY 12804
B 5-LGL 6/06
T&)&
be j -
Septic Inspection Report
Office No. (518) 761-8256 Date InsDectlon request received:
Queensbury Building&Code Enforcement Arrive: am jpm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: -RC-.
NAME: 'fit ` PERMIT NO.: �
LOCATION: INSPECT ON:
RECHECK:
-? Comments and/or diagram
Soil Typet San m/ la
-lyp2,of a .' Munid Well Water
Waterline se istance ft.
Well separation distance ft•
Other wells: •
-Absorption Field: Total length ev ft.
Length of each trench �•
Depth of trenches �•
Size of Stone
Seepage Pits: Number
Size x
Stone Size:
Piping Size TWe
Buildinci to tank
Tank to Distribution Box i+
Distribution Field Pit ci `
OpeniLig 500: V/ N Partial
End Ca
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft•
Conforms as per Plot Plan Y N
En ineer Report and As-Built Y N
Location of System perty:
Front47//�ef
t Side Right Side
Middle Fron Middle Rear
m
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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T kjV-VN OF QUEENS URY
111,11' .
BUILDING & CO D
Reviewed BY:
n,atr,
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