2003-359 TOWN OF QUEENSBURY
742 Bay Road,Queensbur,NY 12804.5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
OF COMPLIANCE
Uhall.FICATE .
Perm t Number P20030359 Date,Issued: Friday,June 13,2003
:xhi-is to�certif that�workrequested to be done-as shown; _Peririit;Number P20030359--
has been completed.
Tax Map Number: 523400-301-020-0001-016.000.0000
Location: 8 EISENHOWER Ave
Owner: DAVID BABINEAU
Applicant: DAVID BABINEAU
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential Town o QuEENSBu>tY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030359 Application Number: A20030359
Tax Map No: 523406-301-020-0001-016-000-0000
Permission is hereby granted to: DAVID BABiNF.AI1
For property located at: 8 EISENHOWER Ave
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 incompliance with the NYS Uniform Building Codes and the Queensbuiy Zoning
Ordinance. 'Type of Construction' Value
Owner Address: DAVID BABINEAU
8 EISENHOWER Ave Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804-0000
J
Contractor or Builder's Name/Address Electrical Inspection Agency
FTJLLFR FWAVATION .
NY 12804-0000
Plans.&Specifications
BP 2003-359
Residential Septic Alteration as per plot plan and specifications.
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,May 30,2004
(If alonger 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 n Quee s u r' a May 30,2003
SIGNED BY for the Town of Queensbury.
ury.
Director of Building&Cade Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,ATY 12804 (518) 761-8256
1. OWNER INFORMATION:
........... .....................................................................
Office Use
Location of installation:
File Permit No. o?0��--36
Tax Map No.
'-D- 6u ) Fee Paid
D
Owner's Name
............... ............... ................
Address:
Fuller Excavation
2. INSTALLER'S NAME Box 136 Hicks Rd. PHONE NO.
Gr-anviiie,-Ny 12832
3. RESIDENCE INFORMATION: (circle yJVA)&A&Q,()1Gdicate#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 1:50 gal/bdrm = 900
1980- 1991 X 130 gal/bdrm =
1991-present X 110 gal/bdrm =
Garbage Grinder Installed yes no
Spa or Hot Tub Installed yes_ no X
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Too graphy Soil Nature Ground Water Bedrock or impervious.Material LW=esiLc Water Su i31v
< 'lat sand-�) at what depth at what depth municipal
Rolling -To—ayn feet —feet well
Steep slope clay well; water supply
%slope other )VIA A)OIVe if from any septic system
depth: absorption is
other
Percolation Test: .(To be completed by-licensedprofessional engineer.or architect)------ ---
Rate: pr,'n minute per inch Lo S 741-1�"
Xk- S,:1,7 / A-e L.
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: gallon (min. size 1,000 gal.)
Tile Field: each trench Total Systein Length: ft. 'C
SeepagePit(s): number of_=Z_ sizeofeach: A9 ft. by
Size of Stone to be used: # depth or thickness 7 feet
Bed System Size: X
Alternative System: length andlor size
6. HOLDING TANK SYSTEM: -(if required)
Number of tanks: I Size of each: _7 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.
101,
Sign ure of responsible person G(ate
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7. SIGNATURE &•UgFORMATION FUTL SkS Pt�7ir�ir�=t �� ex��+•®� �.•�;-" _ _- - --
Septic Inspection Report
Office No. (S 18)761-8256 Date Inspection request received "
Queensbury Building&Code Enforcement Arrive: am/p V,, am/pm
742 Bay Rd., Queens�bury,NY 12804 Inspector's Initials: y
NAME: 3 12LLO PERMIT NO.: �
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/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
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft. jf
Separation of Pits ft.
Conforms as per Plot Plan . Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
Systemise Status
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:lsucHemingway\Bwilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
Septic Inspection Report
Office No. (518)761-8256 Date Inspection' request received:
Queensbury Building&Code Enforcement 'Arrive: -- in/ in Departj: D��ani/pnm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME:
PERMIT No.: 03
LOCATION: 67 INSPECT ON: 6-1
RECHECK:
Comments and/or diagram
Soil Type. an Clay
..Type of Wre'n(Mjuni Oip /Well Water
Waterline separl 'on dis L;Ace
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft,
Length of each trench ft.
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Sixe. TYP5
Building to tank t
T nLc to Distribution Box
,Pistribution Box to Field Pit
V1 Opening Sealed(-Y-_-)/NI Partial
Location/Separations
Foundation to tank
Foundation to absorption C7 ft.
Separation of Pits
Conforms as per Plot Plan
Location of System on Property:
Front Rear Left Side Right Side
IN I 74,jrl
Middle Front Middle Rear
System Use Status:
proved
d
Partial Approved and needs to be re-inspected,please call the'Building&Codes Offce
ME
Di8approved
L:\SueHemingway\Building.Codes.Inspection.FORMS\Se.ptic Inspection Report.doc January 28,2003
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received: t
Queensbury Building&Code Enforcement Arrive: am/ art am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: 13 .—
� ��� PERMIT NO.: G ?j 35
LOCATION: INSPECT ON: Q
RECHECK.:
Comments and/or diagram
Soil Type Sa Clay
T e of Water Municip P1 Well Water
Waterline sea lstance
Well separation distance ft. G ✓" �'/`��
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: .✓ A-� t�JAFG�
• jrtlGN� � �d�L.G-�
rlping Si4e . Type
Building to tank LY)
Tank to Distribution Box u u
Distribution Box to Field/'Pit
'Opening Sealed: Y/ Partial ��,¢L /AC'&i 0,r10-¢%
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan N
Location of System on Property:
Fro Rear Left Side ®Rig� Side ����y`rV� " ' �•r�'� ��iG�ul G"��J
Middle Front Middle Rear
System Use Status:
pr ved
!�Dpisapproved
rtial Approved and needs to be re-inspected,please ca11 theBuilding&Codes Office
LASueHemingway\Building.Codes.InspectionTORMS\Septic Inspection Report.doc January 28,2003
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received: d 3
Queensbury Building&Code Enforcement Arrive: am/p epart: ' am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: �`GQ ! �� t ►'����— PERMIT NO.: �_ �/
LOCATION: ; INSPECT ON: <O JW6 3
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/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 At
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan j Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
S_ystem Use Sta s:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:isueHemingway\Duilding.Codes.Inspeetion.FORMSISeptic Inspection Repoit.doc January 28,2003
III have seen or o¢)snrved, or beliA �-�'� 3-3 J
all ohJeQ s such is 4,% "e I saw evidence of
sl�ewn on this docc. ;M 14lso r trees, fences, etc.,
persaraaif , vl,ta represe�?t that I have
Y measure'
�l�e distances.� es se,, forth on t!n
a° �.
SIG N A T _
"1 DATE
jRY
BUILDING & CODE EPT.
REVIEWED BY FILE .
DATE .
�`L�