2012-244 TOWN OF QUEENSBURY
EIT
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120244 Date Issued: Friday, November 29, 2013
This is to certify that work requested to be done as shown by Permit Number P20120244
has been completed.
Tax Map Number: 523400-308-010-0002-060-000-0000
Location: 45 NICOLE Dr
Owner: WILLIAM & THERESA REDMOND
Applicant: WILLIAM & THERESA REDMOND
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 /1
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
01—
1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120244 Application Number: A20120244
Tax Map No: 523400-308-010-0002-060-000-0000
Permission is hereby granted to: WILLIAM &THERESA REDMOND
For property located at: 45 NICOLE 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: WILLIAM &THERESA REDMOND
45 NICOLE Dr Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
STONE INSTALLATIONS
4305 ROUTE 50
SARATOGA SPRINGS,NY 12866-0000
Plans&Specifications
2012-244
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, May 16, 2013
(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 bury; Wednesday, May 16, 2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code ''nfor\, ent
Community Development Office
Town of Queensbury • 742 BayRoad • Queensbury, New Yor
gyp® C,tUEENSgURY
BUILDING & CODES
Office Use Only f
TAX MAP NO. 20 .1b-D-615 PERMIT NO. 0- a w PERMIT FEE C` D C,��
APPROVALS: ZONIN' TOWN CLERK
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.
OWNER: a e—c-S e.. fry P�Cl r-,c�Y..1 INSTALLER: 674:1 te J-1-, 714j!a A,,,,...‘f f
ADDRESS: /c/ �A C c•1 CF^`. ADDRESS: `f Jar Al-c . c.-6 Se-r,."f"o 54i�1v.?- 1 2 47g6
NOS. 7 yb -? !7Z 7 / -0;z nG PHONE NOS. ?j `.-A 701
LOCATION OF INSTALLATION: 1 AL ,i,I c ..i>i-•,).;c..
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = 9.17 INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING X STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND A 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 3 PER MIINUTE PER INCH[mpi] (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: 1,15-P 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: ^ectlef ell eh4oil c!'f-lige f
ct ABSORPTION FIELD(WITH NO.2 STONE) Total length 02120 ft. Each trench 14 X 6-0 r
o SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
o ALTERNATIVE SYSTEM Bed or other type?
o 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 read the regulations with respect to this application and agree to
abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
San ary Sewage Disposal Ordinance. codes a,queensbury.net
1��Iti'�15:5-11-
Date \, VISIT OUR WEBSITE FOR MORE INFORMATION
Sighaturof Person Responsible
\ wl^.'%'A.,.t IL![ is bur v..11et
` _ '
5-rs
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/p Depart:c7 - am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: R6CIMOncl PERMIT NO.. ._ A
LOCATION: y 5 A) 0 OIL INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loam/ Clay
Type of Water: Municipal / Well Water s-/L_,(3
Waterline separation distance ft. '1(3
Well separation distance ft.
Other wells: ft.
Well Casing •th 50' + / - Y N N/A
[150'to ell equired if NO]
2.vLE- A/ t' >
Absorptio Field Total I•ngth ft. l� - -r'�Iti�i
-ngth o each rench ft. �i - Nt 4
Dept oft enches _ ft. �..\
S •e •f Stone
Seepage Pi I. Number
Size: x MO A-4 �.�
to,e Size: rVI�1��`�
Piping Size Type ,& �,,. r..- f 1��
:uildi • to tank
Tank to l istri.,ution Box
Distribution .ix a Field SPit
in `5 c� v
•.: ing Sealed:
ed: Y_ N �)
End Cap N
Inlet/Outlet 'ipes&Baffles — N
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits
Conforms as per Plot Plan ; _Y_N
Engineer Report and As-Built , _Y_ N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Re-r Left Side Right Side Middle Front Middle Rear
S stem Use Sta
Approv-
•. a Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Repor 03 29 10.doc
fire SAR A ,..„ rc)
r)
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: & -" 5--/,:z
,:
Queensbury Building &Code Enforcement Arrive: am/pm Depar9t am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: L_� ,
NAME: PERMIT NO.: / a- A {/ )
LOCATION: `l &) r L.,9-{6 LA INSPECT ON: LQ—5—J d
ECHECK: '
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water Ki h,,.-----
Waterline
Waterline separation distance ft.
Well separation distance ft.
Other wells: _ ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length c-3z] ft.
Length of each trench ft.
Depth of trenches ft. '7--- r F -1.L- S
Size of Stone k J
Seepage Pits: Number [v
Size: x
Stone Size:
Piping Size Type
Building to tank -___ C � - T
Tank to Distribution Box �` `'`�l0
Distribution Box to Field/ Pit ir--2
Opening Sealed: ,y" N
End Cap ✓ N
Inlet/Outlet Pipes&Baffles . Y—N
Location/ Separations
• Foundation to tank '10L_ ft.
Foundation to absorption --/;2--, ft.
Separation of Pits
Conforms as •er Plot Plan J �, �-1, �)QC�r
Engineer Report and As-Built Y N �f ��
Location of Syste Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S -I Us- -
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
nonda. w
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: (s? -1 a
Queensbury Building &Code Enforcement Arrive: am/ m Depart:c(am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: R� Jr Cin c-i" PERMIT NO.. / l a.94/
LOCATION: q ik) u Att. INSPECT ON: (o• � �„
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loam / Clay
Type of Water: Municipal/ Well Water 0•126- al-Lc''t�
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length each trenchft.
D
Deptt h of trenches ft.
Size of Stone f)
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank A kt`5 n i(S
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: Y_N —�
End Cap Y N
Inlet/Outlet Pipes &Baffles Y— N
Location/ Separations
• Foundation to tank _ ft.
Foundation to absorption 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
S e Use
Approved
- •'al Approved an. needs to be re-inspected, please call the Building &Codes Office
—147 Disapproved
Last revised 06 : e L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
C
I1==n7"-----, -1.' gt.cfyho,cf, t', 1_elc/),ce....
.;?A. :-,gommunity Development Office
,Y L
-_, `',•:',.' 'D wn of Queensbury •• 742 Bay Road •• Queensbury, New York •12804
,= 0.1.1,..6 i -ifii.-.4 C.C...;II z.-'1.1.-- "‘',7 ›•4-4----
1 i in f gLt)1 j_ I l
f ' i(v L c. cc oil ` 3e-c1 rug.•-+
sin ; shBE PROPERTY LINE
11!111 -, 111 ibYi X12 - ,5.1-,., 1 . „ c,
poi ._ ARC -1 U lj'44/clI-cs5
, ,., „ . • ,_
w94--13'. ‘01-1.-it'i'll-k,,5;e.ed i-c.c;:c"):(3
• 1//'tow : '. , ,I. :.- . .. , . .
�: AL we 1.1 S L '1 moi n 7�
MEIN II 111111111111 icP ' 4.:1 .`517:,,,...)"-t 7„7,t f.� � V"----.-1"--4 -
'1 t G ) G. I
W
a-
IIII 111111111111111111
r �reser1t that I have
�����������������������EMI' 1111111■11■■�E�M�IIiii- ,� ces set{girth on the diagram.”
111111111111 II ii
1111
ici i /) , .. ef,r_cd_____ _____,5/4-__5/i2-_- _
Orli ___----------
TOWN OF QUEENSBUFY
BUILDING & Ce a ci�if
Reviewed By:' 41, __
Date: k 7 -