2008-250 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
4E Community Development- Building&Codes (518) 7618256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080250 Date Issued: Wednesday, August 25, 2010
This is to certify that work requested to be done as shown by Permit Number P20080250
has been completed.
Tax Map Number. 523400-289-007-0002-003-000-0000
Location: 19 MOON HILL PI
Owner. JAMES & SHERI WHITING
Applicant: JAMES & SHERI WHITING
This structure maybe occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the +X 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& de Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080250 Application Number. A20080250
Tax Map No: 523400-289-007-0002-003-000-0000
Permission is hereby granted to: JAMES & SHERI WHITING
For property located at: 19 MOON HILL P1
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: JAMES & SHERI WHITING
19 MOON HILL PI Septic Alteration Residential
LAKE GEORGE, NY 12845 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-250
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 30, 2009
(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 f Que bury; F iday, May 30, 2008
SIGNED Br for the Town of Queensbury.
r of BuildYig& e Enforcer_lent 'r;
%_._._. ._.-...............' ON_y
OFFICE USE _______________ ____�F� 1Vn -�+
s
rA�01 TAX MAP NO. PERMIT NO. ERMIT FEE 0 % n
APPROVALS: ZONING TOWN CLERK 1
Bull
APPLICATION FOR SEPTIC DISPOSAL SYSTEM
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. r--�
OWNER: ` INSTALLER:
ADDRESS: ' ' C_ ADDRESS: ( 54
PHONE NOS.
` PHONE NOS.
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply f om any septic
system absorption is d^ ft.)
✓ PERCOLATION TEST: Rate is 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: 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:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length 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 regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensbu Sanitary Sewage Disposal Ordinance.
codes@queensbury.net
/ VISIT OUR WEBSITE FOR MORE INFORMATION
��-(/ / www.ciueensbury.net
Signature of Person Responsible Date
Town of Queensbury • Community Development Office - 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
-/h
Septic Inspection Report
Office No. (518) 761-8256 Date Ins n request received:
Queensbury Building&Code Enforcement Arrive: amJ Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspecto s I lbals: " C
NAME: Ai PERMIT NO.:
LOCATION: f INSPECT ON: --
RECHECK:
' Comments and/or diagram
Soil T Loam/Clay"
Type of WatY. Municipal/
Waterline separation distan ft.
Well separation distance ft.
Other welts: ft.
Absor tion Field: Total length ft.
Length of each trench ft.
-Depth of trenches ft.
Size of Stone ry
Seepage Pits: Number We
Size: x
Stone Size:
PipingSize T ne
Building to tank 1
Tank to Distrlbu n Box r --2 Q
Distribution Box WIVeld Pit
Opening Sealed: N Partial
End
In Ou Pipes&Baffles Y N
Location Se rations
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
Loca ' stem on Property:
ont Rear Left Side Right Side
Mid a Fran Middle Rear
m s•
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes ofF�e
Disapproved
Last revised 021006
Last revised 1/6/05
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