2006-595 41111a 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. P20060595 Date Issued: Wednesday, January 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20060595
has been completed.
Tax Map Number. 523400-300-016-0001-011-000-0000
Location: 216 FULLER Rd
Owner DEBORAH FERRANTI
Applicant: DEBORAH FERRANTI
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 41
property owner of the responsibility for compliance with Site Plan, (..."W )0(----
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: P20060595 Application Number. A20060595
Tax Map No: 523400-300-016-0001-011-000-0000
Permission is hereby granted to: DEBORAH FERRANTI
For property located at: 216 FULLER Rd
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: DEBORAH FERRANTI
216 FULLER Rd Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2006-595
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, August 23, 2007
(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 Toy/hi)? eensb ' ; W9d •sday, August 23, 2006
SIGNED BY for the Town of Queensbury.
`�- Qu rY
Director of Building&Code Enforcement
For an EPA homeowner's guide: htto://www.epa.gov/npdes/pubs/homeowner guid long customize.pdf
c -� ,I b - r - II OFFICE USE 06:515-PERMIT
y ` EC s '.t / D
TAX MAP NO. PERMIT NO. 06�5-PERMIT FE£E- ; }9
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/ •
AU(; % 2006
APPROVALS: ZONING TOWN CLERK •
, TOWIt l i( �;,_=�ya8e1RY
vt)CODE
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. y_ 1 - /(flc OWNER: I>J-e 6 I —tr rA 1 t INSTALLER: Ed M.` r -, ' �A S i- . 1c.
ADDRESS: 2j (a ("✓I (er geA ADDRESS: f 1 a' k in II-el !v . S. Ser `^ -is- N`1 (ZS(G
PHONE NOS. .79 S — 53?I / PHONE NOS. 5-I X" SI 2- 1 G 2S
.
LOCATION OF INSTALLATION: -i C FV 1 Le, i2,4
-- - RESIDENCE
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
BEDROOMS
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED?
1981-1991 X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA OR HOT TUB
INSTALLED?
PARCEL INFORMATION: * 0111/ r plot&'n, Qx i S il” tar) k �D ofh.er or k rnVO Ned ,
/ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? 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 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 architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: 1 )G°o GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
o ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
o 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 -ad the regulations with respect to this application and agree QUESTIONS? CALL 761-8256 OR EMAIL
to a.'.: c• .ese and all requirements of the Town of Queensbury codes a(�.queensbury.net
Sa t;e f.ew:.: b sposal Ordinance.
,/
23/06 VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
k
Signature of Person Responsible Da e
QTown of Queensbury • Coiiiniiiiiity 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: amp Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector`s Initials:
NAME: fa/LeiA'NT7 PERMIT NO.: 66
LOCATION: lc-0 INSPECT ON: Z5.7aCto
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft. ��Ns� �QC�/p�(�- Lir�N
Well separation distance ,
Other wells: ft.
Absorption Field: Total length ft. ) I
Length of each trench _ ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Sizgr 6r Type
Building to tank �, 5 C P
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y/ N/ Partial
End Cap
Inlet/Outlet Pipes&Baffles "(...._..
N
Location/ Separations
Foundation to tank (C) ft.
Foundation to absorption _
__s ft.
Separation of Pits — --ft.
Conforms as per Plot Plan ✓Y N
Engineer Report and As-Built Y—N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Statin
�/ 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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