2013-452 TOWN OF QUEENSBURY
742 Bay Road, uccnsbu NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130452 Date Issued: Tuesday, October 22, 2013
This is to certify that work requested to be done as shown by Permit Number P20130452
has been completed.
Tax Map Number: 523400-301-008-0002-058-000-0000
Location: 7 PROSPECT Dr
Owner: JEFFREY CHAD RICHARDS
Applicant: JEFFREY CHAD RICHARDS
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 i
P G74ct
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.
Oek TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130452 Application Number: A20130452
Tax Map No: 523400-301-008-0002-058-000-0000
Permission is hereby granted to: JEFFREY CHAD RICHARDS
For property located at: 7 PROSPECT 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: JEFFREY CHAD RICHARDS Septic Alteration Residential
AMANDA M RICHARDS Total Value
7 PROSPECT Dr
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2013-452
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, September 25,2014
(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 To of Qu nsbu 04Wg e�+a September 25,2013
SIGNED BY Id
for the Town of Queensbury.
Director of Building&Code Enforcement
orrice use only
Town of Queensbury Building & Codes Received:
Tax Map ID: 30I _ -C
sS
SEPTIC DISPOSAL PERMIT . -
Permit No.:
A permit must be obtained before beginning construction Permit Fee:
Approvals:
Applicant: I- 4(o5fe 17cw-k- Installer/Builder Ce i-C-
Address: Nw Jr( 1a9 '-t Address
Phone: 5-19 Phone
Owner: SO w.r Location of Installation �r,c k y1/44 JA
Address:
Phone .{r 2013
Contact Person for Building&Code Compliance: Day Phone: 76/-8a5-6
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older 3 x 150 = LIs"o Garbage Grinder installed? w
1981 -1991 - x 130 = Spa or Hot Tub Installed? iti)C5
1992-Present x 110 =
Parcel Information: X
Topography Flat Rolling Steep Slope %Slope
Soil Nature X Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious Material A)what depth?
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- per minute 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 t i()0 gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(with#2 stone) Total length ft. Each trench X
Seepage Pit(S)(with#3 stone) How many? Size?
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. There will be no exceptions.
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 Sanitary
Sewage Disposal Ordinance. \
Print Name: SQ-St -�� e- �p< � `d tctl
�Nscit Date: /)_-1
QW, 1 i�
Signature: \W, /N� Date: 1a�( r)
"own of Queensbury Buildin &Codes Septic Disposal Permit 518-761-8256
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: ) ,
Queensbury Building &Code Enforcement Arrive: am/ De art• cc am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: R Ceti1` 1 PERMIT NO.: 3
LOCATION: 7 r'Q S fNer 4- INSPECT ON: /0 '5 -1 3
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal / Well Water
Waterline separation distance t .
Well separation distanceJkzft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft. � 1
Length of each trench ft. t,
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank Al c
Tank to Distribution Box ,
Distribution Box to Field/ Pit V
Opening Sealed: Y N
End Cap pa. N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade _ N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank ft. '�2-017.i
Foundation to absorption _ft.
Separation of Pits ft.
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 Rear Left Side Right Side Middle Front Middle Rear
System Use Sta s:
App o
Pa ial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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