2003-390 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF 0 P C � LIANCE
Permit Number: P20030390 Date Issued: Friday,June 06,2003
This is to certify that work requested to be done as shown by Permit Number P20030390
has been completed.
Tax Map Number: 523400-297-006-0001-057-000-0000
Location: . 7 COBBLESTONE Dr
Owner: BRIAN&FABIENNE DREITLEIN
Applicant: BRIAN&FABIENNE DREITLEIN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Quemsbury,NY 12804-5902. (518)761-8201
Commiinity Development Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: - P20030390 -Application Number: A20030390
Tax Map No: 523400-297-006-0001-057-000-000.0
Permission is hereby granted to: BRIAN&FABTF,NNF,DRETTLEIN
For property located at: 7 COBBLESTONE Dr
in the Town of Queensbury,to construct or place
at the above location m* accordance with application together with plat 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: BRIAN&FABIENNE DREITLEIN
7 COBBLESTONE Dr Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
CRANDALL F,XCAVATING
' s
Plans&Specifications
2003-390
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT PEE PAID-THIS PERMIT EXPIRES: Saturday,Juue 05,2004
(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.)' r'
Dated at the Town of Queensbury, Thursday,June 05,2003
SIGNED BY I for.the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1 OWNER INFORMATION:
............................................................................. ........... .........
Office Use
-7 Q Location of installation:
C
File Permit No. <9003 2) 1 D
Tax Map No.
Fee Paid QL
Owner's Name:
.................................................................................................................
2. INSTALLER'S NAME PHONE No. 7
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flaw)
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 = REECEIVED
Garbage Grinder Installed yes no Z___ JUN 0 4 Z003
Spa or Hot Tub Installed yes no TOWN OF QUEENSBURY
BUILDING AND CODE
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography . Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
_-RA2t—_ Sa d at what depth at what depth ]pal
Rol—I&__> Cloam" 1F,0 feet feet
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is /10 ft.
other
Percolation Test: .(To be completed by licensed professional engineer or architect)
Rate. Z6'5filnuteper 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,ch Garbage Grinder,Spa or Whirlpool Tub.
-Z
Septic Tank: gallon (min.sho,000 gal.)
Tile Field: each trench ft. Total System'Length: ft.
Seepage Pit(s): number of :: '�-- size of each: '7-- ft. by --fit.
Size of Stone to be used: # 2— depth or thickness feet
Bed System Size: x 6
Alternative System: length andlor size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: i 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 13 6-29 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.
Srqnature of responsible person Da Ce-
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7. SIGNATURE &INFORMATION FOXL F-V-SrVi WJNU r�
Septic Inspection Report
Office No. (S 18)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ art: �- am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: t R6rr(T k
PERMIT NO.: �TO
LOCATION: c —y�� HL —S INSPECT ON: <1 D�
RECHECK:
Comments and/or diagram
Soil T e: Sand/ o /Clay
Type of Water: Municipal/ ell Wate
Waterline separation distanc ft.
Well separation distance ft.
Other.wells:
...Absorption Field: Total len II CaQ ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone rfj
-Seepage Pits: Number
Size: x
Stone Size:
Piping Siz Type
Building to tank
Tank to Distribution Box �,�
Distribution Box * , field/Pit �t
Opening Sealed:I-V I N/Partial
Location/Separations I
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan .Y N
Location of System on Property:
0
Front Rear Left Side Right Side
Middle Front Middle R ar
S stem Use St us•
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\.SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
RECEIVED
JUN 0 4 HD
A� __._..._. TOWN,OF QUcENSBURY
-----.� BUILDING AND CODE
D ,
SL
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"I have seep or observed,or believe 144i,W ; r �
all objects,suoh as houses,wells,frees,fences,,etc,,
jai Jr�� show o this document, I also r'eprese
0016 Co !!
Per II �� � � d
p y measure sfaoces set forth on the diagram,
'SIGNATURE DATE