2012-472 OW, TOWN OF QUEENSBURY
742 Bay Road,Qucensbury,NY 12804-5902 (518) 761-8201
41.11.
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120472 Date Issued: Friday, August 30, 2013
This is to certify that work requested to be done as shown by Permit Number P20120472
has been completed.
Tax Map Number: 523400-239-016-0001-001-000-0000
Location: 5 GREY LEDGES Dr
Owner: THOMAS & JUDE CATLIN, TRUSTEES
Applicant: THOMAS & JUDE CATLIN, TRUSTEES
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 4
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
742 Bay Road,(1uem.d)Ury,NY 12804-5902 (518)701-82,01
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Pet-mit Numbei-: P20120472 Application Number: A20120472
Tax Ntap No: 523400-239-016-0001-001-000-0000
THOMAS & .UDE CATLIN. TR[J STEES
For Property located at: 5 GREY LEDGES Dr
in the'l'0W1l Of QUeCtisbury, to construct,ur place
at the ,
above location in accordance with application together with plot plansand other inforn-lation hereto Filed
and approved and in cornpliance with the NYS t-7niforril Building Codes and the QueenSbUry Zoning
Ordinance, Type of ConstrIaCtiOn value
Owner Address: THOMAS & JUDE CATI-KTRUST Septic Alteration Residential
SARAH CATLIN LANDERS, 'I'RUSl I'mal Value
17C FAIRWAY Dr
Mf,'C]-IANICVILLE,NY 12118-OOOC
Contractor or Builder's Name / Address Electrical Inspection .Agenic}
ELLSWORTH & SON EXCAVATING
57 E'LLSWORTFI Ln
LAKE GEORGE1, NY 12845-0000
Plans & Specifications
2012-472
Res, Septic Alteration
S40.00 PERMIT FEE PAID-TT-TTS PERMIT EXPIRES: Thursday, September 26, 2013
(If a longer period is required,an application for an cxteo,%ion must be made to the code Enforcem"it Officer
of tine Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury;
Wednesday, September 26, 2012
S I(;N ED BY for the Town of Queensbury.
Director of Building& Code E'nforccment
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only Q,
TAX MAP NO. 3 1 , I (A — I—) PERMIT NO./ IN?c7.. PERMIT FEE _
APPROVALS: ZONING 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: 7,10,E c s COSH(.n INSTALLER: E/IS INOr iA 4 BOA S
ADDRESS: S Gel/It) De ADDRESS: 6/fS01 Lav ee Lok( 6eo-
PHONE NOS. 65-4 -5 7A f 60- 194g PHONE NOS. ?IA- 9 ) /
LOCATION OF INSTALLATION: s VC/ 5-6 .9R) po ate 9L
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = 360 INSTALLED? A/6'
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? NO
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING / STEEP SLOPE %SLOPE
✓ SOIL-NATURE: SANDL AM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? i\J
✓ BEDROCKAMPERVIOUS MATERIAL: AT WHAT DEPTH? i" ft-
✓ DOMESTIC WATER SUPLY: MUNICIP WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS P 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: ilcc 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. CP
(,zMii- j TINA-
NA o/ /7 t'Ct i,efv.-v ��S �iJ t ydt
k ?
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO. 2 STONE) Total length ft. Each trench X
❑SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
0 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 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
Sanitary Sewage isposal Ordinance. J codes(a.queensburv.net
/le/ 3- VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Ins.- ion • •- --,iv-•
Queensbury Building &Code Enforcement Arrive: •-part: • B
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: TL 'E' IT NO.:
LOCATION: 5- :(zE`t \)S\ I PECT ON: 9. —7jh— i
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches _ ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N
BUftT
End Cap YN AS
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade Y_ N
[provide extension collar if Yes] Y_ N
Location/ Separations
Foundation to tank -
Foundation to absorption ft.
Separation o ft. V E_C E\� �- A p BU
1�1J, ' Cr--
Conforms as •- ' of Plan N J"-
Engineer Repo 'and As-B ' APY 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 s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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Septic Inspection Report
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Office No. (518) 761-8256 Date Ins•.- ion r- - -i ' `)-S -mm t 3
Queensbury Building &Code Enforcement Arrive: - 7 • 4!•II=.art: "Effrefflr
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia ��
NAME: 9tli 0,,,y,tAl_. PERMIT NO.: -
LOCATION: A1)6'1,4.-
1/ INSPECT ON: AM 13
RECHECK:
Comments and/or diagram
Soil Type a j Clay
Type of Water: MunicipaleIl,Water .ice �4�
Waterline separation n e ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
lam,
Absorption Field: Total length
Length of each trench (,,,---------2:;a
Depth of trenches j� ft.
Size of Stone
Seepage Pits: Number ________
Size: x
Stone Size:
Piping Size Type
Building to tank1.-)4A-k-
t `-t u
Tank to Distribution Box Lt i .,; \---u LyL‘2,T, �-).
Distribution Box to Field / Pit
Opening Sealed: N/Y N
End CapY N
Inlet/utlet Pipes & Baffles —. ,_ N
Manholes 12"or less below grade ,V/ N
[provide extension collar if Yes] N
v
Location / Separations
Foundation to tank ft. ,A15- v
Foundation to absor•tion ft. . ---,,----C1. ...) t'
Separation of Pits / ft-.. v'r U
Conforms as per Plot Plan �Y N/�
Engineer Report and As-Built ^Y ✓fii
ETU Maintenance Contract Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forrns\Septic Inspection Report`03 29 10.doc
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