2013-516 � 1k TOWN OF QUEENSBURY
742 Bay Road, NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130516 Date Issued: Thursday, October 31, 2013
This is to certify that work requested to be done as shown by Permit Number P20130516
has been completed.
Tax Map Number: 523400-301-012-0003-015-000-0000
Location: 11 HILLCREST Ave
Owner: GEORGE & MARGUERITE L FERGUSON L.E.
Applicant:
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 (------3P )(//,<-
property owner of the responsibility for compliance with Site Plan, av
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.
004 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130516 Application Number: A20130516
Tax Map No: 523400-301-012-0003-015-000-0000
Permission is hereby granted to:
For property located at: 11 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: GEORGE & MARGUERITE L FERG Septic Alteration Residential
RENEE JOHNSON,EILEEN TARAN Total Value
GEORGE R., JOHN &TIMOTHY FE
11 HILLCREST Ave
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans&Specifications
2013-516
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,October 30,2014
(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 Town of Queensbury; Wednesday, October 30,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York -12804
OCT 3 0 21113
Office Use Only /`--
TAX MAP NO...3 b • 1 a - 3- 15 PERMIT NO. /3-51 LO PERMIT FEE 0 /11,77��
APPROVALS: ZONING TOWN CLERK r
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: G Pexis-G� e: 13 0 INSTALLER: r 2 s C e O'itt l/- ////_\J`y�
ADDRESS: I ' I c I \ (i51 j\ve • ADDRESS: 1 L Ower v V C1rt••Us 'Si. Q D J'
PHONE NOS. —1 93 I 11'1 PHONE NOS. —1( PS.-- S 1 f)\‘
LOCATION OF INSTALLATION: 1 \ H 111 c re i k/R_
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = 3 0 0 INSTALLED? NA
1981-1991 X 130 = SPA OR HOT TA
1992-present X 110 = INSTALLED? 1V 11
PARCEL INFORMATION: p
✓ TOPOGRAPHY: FLAT ROL G STEEP SLOPE`y (\ \i
% SLOPE[`� 1.
✓ SOIL NATURE: SAND ` Q�`LLOJAM IV - CLAY N I� OTHER`�J 1k
✓ GROUNDWATER: AT WHAT DEPTH? IV f 1
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA DEPTH? \V!T \f
✓ DOMESTIC WATER SUPLY: MUNICIPAL V WELL 1\*(If well:water supply from any septic system absorption is\\ I"\ ft)
✓ PERCOLATION TEST: RATE IS \\IN PER MIINUTE PER INCH[mpij (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: t 000 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.
SYSTEMPE: r
ABSORPTION FIELD(WITH NO.2 STONE) Total lengthn ft. Each trench �
`I X )
❑SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Ni►v Size? IV
❑ALTERNATIVE SYSTEM Bed.or other type? Y \ . t. r f
, Iv 7
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? , Number of tanks? N) 1\
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 thes- and all equirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary "Di sal Ordinance.
JD-3I_ codes(aaueensburv.net
Signat e o Per Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburv.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: 7 am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: Fe$Lt S v,r) PERMIT NO.: /3 f W
LOCATION: J/ H1/10./-&_S-j- INSPECT ON: / "-3 j-/
RECHECK:
Comments and/or diagram
Soil Type. San Loam / Clay
Type of Water: Municipal / Well Water
Waterline separation distanceft.
Well separation distance ..1=••ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length
Length of each trench S2— ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: ,1?
Stone Size:
Piping Size Type
Building to tank 2 f• l. t- --
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: _ _ N
End Cap N
Inlet/ Pipes&Baffles /
Manholes 12"or less below grade _Y Nip Ar--
[provide extension collar if Yes] Y vN `
Location/ Separations
Foundation to tank _ft. —1_,+.7.1•V- v)--.-t.
Foundation to absorption ZL
Separation of Pits /�11 .
Conforms as per;14 Plan _ N
Engineer Report anBuilt `,, N
ETU Maintenance Contract Y_ N
provided
Location of System •- • operty:
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 Forms\Septic Inspection Report03 29 10.doc
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