2005-805 TOWN OF QUEENSBURY
742 Bay Road,Queensburv,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050805 Date Issued: Wednesday, October 12, 2005
This is to certify that work requested to be done as shown by Permit Number P20050805
has been completed.
Tax Map Number: 523400-301-008-0002-077-000-0000
Location: 37 HILLCREST Ave
Owner: PAUL GIRARD
Applicant: PAUL GIRARD
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 nforcement
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: P20050805 Application Number: A20050805
Tax Map No: 523400-301-008-0002-077-000-0000
Permission is hereby granted to: PAT JL CTTRARD
For property located at: 37 HILLCREST 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 in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: PAUL GIRARD
10 SARATOGA Ave Septic Alteration Residential
Total Value
SO. GLENS FALLS, NY 12803
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2005-805 SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, October 12, 2006
(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 Town of ueens ry; edq a ber 12, 2005
SIGNED BY 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
Location of installation: C QfT
File Permit No.
Tax Map No.
n Fee Paid
Owner's Name: r1
................................................... ..........
i J . .
Address: —A�
2 INSTALLER'S NAME PHONE NO. / / 2" 72
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 L/
Spa or Hot Tub Installed yes! / no
4. PARCEL INFORMATION: (circle applicable information& indicate measurements)
Topography SoiLNature Ground Water Bedrock or Impervious Material Dom Water Su 1
Flat sand at what depth at what depth unici
Rolling m feet feet
Steep slope clay if well; water supply
_Ya slope other from any septic-system
depth: absorption is f t.
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: J Q�V gallon (min. size 1,000 gal.)
Tile Field: each trench ft. Total System Length:
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # ! 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 ensburyre 2WMle
ewage Disposal Ordinance.
\ ,,,�4, �
i natu J7=�
person Date
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
ti
SEPARATION REQUIREMENTS
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Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
PON
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W ai.,. *61
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Septic Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: —am/pm
742 Bay Rd.,Qu ury,NY 12804 Inspector's Initials:
NAME: _ PERMIT NO.: 0
LOCATION: �' ' INSPECT ON:)
RECHECK:
Comments and/or diagram
Soil Typ San /Loam/Clay
Type of Wate M cr al Well Water
Waterline se aration istance
Well separation distance ft.
Other wells: ft•
Absorption Field: Total length G3' .> ft. �1L �' �7
Len h of each trench ft.
Depth of trenches '?s ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size T e
Building to tank
Tank to Distribution Box
Distribution Box 19 FieljPartia
Opening Sealed: /NJ
End Caps
Location/Separations
Foundation to tank fi ft.
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of Syste on Property:
Front tearAeft Side Right Side
Middle Front Middle Rear
System Use Sta
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
TOWN OF OUEENSBURY
BUILDING & CODES DEPT.
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THIS PLC"�A PROJECT SITE A�T ��
ALL TIMES FOR
THE DURATION OF
CONSTRUCTION