2008-547 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE (3-IFF7 COMPLIANCE
Permit Number. P20080547 Date Issued: Thursday, August 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20080547
has been completed.
Tax Map Number. 523400-301-008-0002-084-000-0000
Location: 38 HILLCREST Ave
Owner. STANLEY LANGWORTHY LIFE USE
Applicant: STANLEY LANGWORTHY LIFE USE
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
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&Cod Enfo ment
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: P20080547 Application Number. A20080547
Tax Map No: 523400-301-008-0002-084-000-0000
Permission is hereby granted to: STANLEY LANGWORTHY LIFE USE
For property located at: 38 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: STANLEY LANGWORTHY LIFE U
SCOTT LANGWORTHY &JILL LA Septic Alteration Residential
38 HILLCREST Ave Total value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: WAN BELL
2 LOWER WARREN St
QUEENSBURY, NY 12804
Plans &Specifications
2008-547
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, October 15,2009
(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 of nsbury;/ r` ednesday, October 15,2008
SIGNED B7l 4 for the Town of Queensbury.
Director of Building&Code Enforcement
/III/I rIrI�.�..►...II r.II rr I.r . ....................III►.r►►�►..rl........................ ,I
i OFFICE USE ONLY . + ; �%
30
`y +
TAX MAP NO. PERMIT NO. r PERMIT FEE l
APPROVALS: ZONING TOWN CLERK
+ + +
►................... ....... i.....................i
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. <- I i
OWNER: �'� ��/ ��4f INSTALLER: R � �4®< C
-IrADDRESS: Wr ADDRESS:
PHONE NOS.—
PHONE N.S. _____z,._____•�,_
LOCATION OF INSTALLATION: �a r►a— 6aw
». ...NO.OF»» ......... ».........»........... .....»..........................
.............»»...........t RESIDENCE INFORMATION:
YEAR BUILT.
BEDROOMS X µ COMPUTATION- _ »TOTAL DAILY FLOW
» isso or older . ».i0»4».....»... ...................»..........:}....... n .,........ ►i;
GARBAGE GRINDER
a lon per bedroom _ } .. » ��1 »v INSTALLED?
1961 -1981 X 130 gallon per bedroom =
x.»....•»....»....•........»........•........•.......................».........................................»............_..»..................................».................................................»..»....»................
SPA OR HOT TUB
»...1982,present...» ...............................»....»...».•..»X..........»11.0 gallon per bedroom .�'.`......»........•....•......,.....,........•......»...»....•...•.....•.... INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND IL LOAM CLAY OTHER
✓ GROUNDWATEL� T WHAT DEPTH? BEDROCKIIMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
—
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION iS FT.
✓ PERCOLATION TEST: RATE IS l� APER MIINUTE 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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.,
✓ SEPTIC TAN G LLON (MIN. IZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH,, , FT.
✓ TOTAL SYSTEM LENGTH:' 1 FT. SEEPAGE PIT(S): HOW MANY? _
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED:# 1 DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: ,Z'Z4 X
✓ ALTERNATIVE SYSTEM: A LENGTH AND/OR SIZE—,Z
HOLDING TANK SYSTEM:(If required) NO. OF TANKS:-.,L�!+' "/SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
VI.1•IrNI•I.xlr{.1•..1.••xl•xl•NNx14.1»•1.1.1•I•x{•.•1..•xl»•x..1.{•{.1•NI•lu•,•...•1.1•{•1.1.1.1.1»•1•xxl•V NV l•NNIN.N.•1.1•NIN»•1•NNI.1•.•I.x.»•I».1»•I•xN{.xNxvl•x»I.1•.•xN{�{•{»•.»•1•Y1.1•x.4.W..1•.•{.1•.•.•{•{•x.•.•{•N{•{.1.1.1..•1•{•Nx.•1.1•Vx••1•NN..NN.».1•xl•N{•1•V{•.•.»»»»»•
l NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN jE
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
•.{.i.,.NI4.1.1.1...1.14•!.1•I.1•{•1•{•..,•{•{».,.., V........{•..1•i•.•1.1•.•1• I i•1•:•{•1.1.1V•1.1.1.1.1.1�{•1.1.{.Nxl•i•;.:•t4.1•,•:•:.i•N!.1.{•i•{•i•:•i.••1•{•.•.•1.1•.•i•.•1•.•1•y.1•:•.•.•1•{•{•{•{.1.1•.•1.1.1•{•1•.•t•1•..,•N.•.•1•N.•.•{...1•••{•.•I•I•.•{•.•i•1.1.1.1...{.1.1.1.14.1.1.1•NI.1•.•1•I.,r,.,•1�1.1•�
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 761.6256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance.
codes 0aueensburv,net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.clueen urv.net
Signature of Person Responsible Date
Town of Queensbury ■ Community Development Office 742 Bay Road, Queensbury, NY 22804
Septic Inspection Report
Office No. (518) 761-8256 Date Ins
req received:
Queensbury Building&Code Enforcement Arrive: am�rt: am/pm
742 Bay Rd., Queensbury, NY 12804 In I itials.
NAME: L,9 +�� Y PERMIT NO.: /
LOCA IO ct'��Z" INSPECT ON: U
Comments and/or dlagr m
Sail Type- Sand Loam/Cla
Type of Aater.Aunidpal Well Water
Waterline searation distance ft.
Well separation distance ft.
Other wells: ft,
Absorptlon Field: Total length ft. dN L-Y
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping i Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y NJ Partial
End Ca
Inlet/Outlet Pipes&Baf0es V Y N
Location/ Se rations
Foundation to tank ft.
Foundation Wabsorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of Sy n Property:
Front Rear Left Side Right Side
Middle Middle Rear
Syjgm U5C Stat
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
or believe I saw evidwe of,
il%mvs'es' wells'trees, fences, et"
c,-v I also represent that I haw,"
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