2012-270 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: P20120270 Date Issued: Wednesday, June 06, 2012
This is to certify that work requested to be done as shown by Permit Number P20120270
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 /J
property owner of the responsibility for compliance with Site Plan, J� /i f
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.
1
TOWN OF QUEENSBURY
f742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120270 Application Number: A20120270
Tax Map No: 523400-301-008-0002-077-000-0000
Permission is hereby granted to: PAUL GIRARD
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
SO. GLENS FALLS,NY 12803 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2012-270
Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,June 05,2013
(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 rtree5bury ATue. s ay/Ju i • 05, 2012
SIGNED BY �Nib for the Town of Queensbury-.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only ( = dam;
TAX MAP NO. 3a I g.r�` 1J 1� PERMIT NO. ! w) PERMIT FEE V� �
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE�IIO/RK BEGINS. APPLICATION IS SUBJECT TO REVIEW EFORE ISSUANC OF A VAT PERMIT.
OWNER: C (-'1-C-J ( Z A-�' INSTALLER: 4 N/ ;74-5, � (1 ,
ADDRESS: I D --1�" SCF ADDRESS:_ a -22-y F _
PHONE NOS. '7 96 — `fd P- PHONE NOS. 7 9G, — O cS `)
LOCATION OF INSTALLATION: 7 14 i l Cgr,s.
_ RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = SS INSTALLED? c7
1981 -1991 X 130 = SPA OR HOT TUB 00
J
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING ` _ STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND / LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA J"DEPTH? _
✓ DOMESTIC WATER SUPLY: MUNICIPAL_IWELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS 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:(, ) _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 TY
ABSORPTION FIELD (WITH NO.2 STONE) Total length��`i ft. Each trench � X '/ _
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? _ Size?
❑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 read the re•u a .- with respect to this application and agree to
these an II re ui . ents of Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
anita Sewag isp•-:l O-.inanc . /i j` codesaqueensburv.net
g ture of Person ^esponsible Date / VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
. d[520,--1., 10 A-0 0—(C)-'OP--
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: C•=_ /__&_`r1 / 3—
Queensbury Building &Code Enforcement Arrive: am/pm Depart: l ` ' am/pm
742 Bay Rd., Queerikiry, NY 12804 Inspector's Initials
N Czt.c-C. & 1 G;1--t • - "r5. N1 O
AME: PERMIT NO.:
LOCATION: 5'74716rfirt,_ INSPECT ON: ' Iff L3/.,)-
RECHECK:
Comments and/or diagram
Soil Type••� Loam / Clay
Type of Water: 'u -... / Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length '°PZ- > ft.
Length of each trench —ft.
Depth of trenches '1_-t-. ft.
Size of Stone -$ --z,..,
Seepage Pits: Number
Size: IN x
Stone Size:
Piping Size Type ��
Building to tank -- �'- ,I _ , —
Tank to Distribution Box ----r-KQ<;,
Distribution Box to Field / Pit Ar._ �,,4--3,g"Opening Sealed: _N
End Cap YY N
Inlet/Outlet Pipes&Baffles T Y - N
Location/ Separations
Foundation to tank ft. - ---60.-5
Foundation to absorption - ft. --z,
Separation of Pits ft.
Conforms as per Plot Plan _ �--�
Engineer Report and As-Built Y. N
Location of System . • operty:
Front Rear Left Side Right Side Middle Front Middle Rear
S t-m 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
1,i have seen or observed, Or believe I saw evidence of,
all objects such as houses, wells, tr•-s, fences, etc.,
shown o. } r ,-hent. I also re7esent that I have
ij
;,,onaiiy ilk A le distalce set f firth on the diagr-rn,"
/ /
, SIGNATURE DAL
i
I
1 /o, I
I o
/OD° 7gti,
aOK 0 sc-,F �
•
•
4
/6 )