2004-752 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: . P20040752 - Date Issued: Monday, September 27, 2004
- -This is to__cerdfy that work requested.to be.done as shown by Permit Number P20040752
has been completed.
Tax Map Number: 523400-302-018-0001-016-000-0000
Location: 16 HIDDEN HILLS Dr
Owner: LEONARD &NANCY CAWAGNONE
Applicant: LEONARD &NANCY CAMPAGNONE
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: P20040752 Application.Number: A20040752
Tax Map No: 523400-302-018-0001-016-000-0000
Permission is hereby granted to: TRONARD &NANC'Y C;AIVTPACTNONF.
For property located at: 16 HIDDEN HILLS 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: LEONARD &NANCY CAIVIPAGNO
16 HIDDEN HILLS Dr Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-752
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 23, 2005
(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 ueens ur day, September 23, 2004
SIGNED BY for the Town of Queensbury.
Director of Building&Code kforcement
Application for Permit=Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12.804 (518) 761-8256
1. OWNER INFORMATION: -
...............................................Office Use
Location of installation: ,.....,....,....
�� : File Permit No�
Tax Map No ,,
ee Paid
nc &
Owner's Name: J -
Address: 1
2. INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm = -
1980— 1991 x 130 gal/bdrm = ��
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes_ / no* - "
Spa or Hot Tub Installed yes_ / no
RECEIVED
4.' PARCEL INFORMATION: .(circle applicable information&indicate measurements E P 2 3 2004
To-mograDhv SoiLNature Ground Water Bedrock or Impervious Ma Vr Su 1
07 Iqsa 0n at wh t depth at wh depthRolling am /Y feet feet
Steepslope clay P y if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate? minute per inch `
5. 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: g n:(min. size 1,000 gal.)
Tile Field: each trench So ft. Total System Length: 200
L
Seepage Pit(s): number of �- size of each: ft, by
Size of Stone to be used: # c2--� depth or thickness feet
Bed.System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 Queensbury Sanitary Sewage Disposal Ordinance.
Si atuoe -rresp6 Bible erson Date
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Septic Inspection Report
Office No. (518)761-8256 Date Inspe 'on quest received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd:, Queensbury,NY 12804 Inspector's Initials:
NAME: _ Q PERMIT NO.: 0 l
LOCATION: S SPECT ON:
RECHECK: e
Comments and/or diagram
Soil Type: 19and Loa Clay
Type of Wa . unici /Well Water �—
Waterline separation distance / 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
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit C/
Opening Sealed: Y N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Se aration of Pits ft.
Conforms as per Plot Plan. N
Location of System on Property:
Front ea Left Side Right Side
e
Middle Front Middle Rear
System Use St us:
Approved
Partial Approved and. eeds to be-re-inspected,please call the Building&Codes Office
Disapproved
L:wSueHemingway\Building.Codes.InspectionX RMS\Septic Inspection Report.doc January 28,2003
MAP REFERENCE _ i
-E
HIDDEN HILLS SUBDIVISION u,
MADE FOR RALPH 8 MICHAEL WOODBURY Q
BY VanDusen d Steves DATED MARCH 26 , 1986 � Q LEONARD J. & NANCY J. CAMPAGNONE
FILED SEPTEMBER 22 , 1986C=
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ec o MAP OF A SURVEY MADE FOR
w° L EONARD J. 8 NANC Y J. CAMPA GNONE
TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK
f Q SCALE : I" = 30' DATE : OCTOBER 23 , 1987
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VanDusen & Steves
LAND SURVEYORS , GLENS FALLS , NEW YORK
N. Y. STATE LIC. NO. 35617 ►,e.�, �'�,� ram,o F"o""'ram _
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