2007-426 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20070426 Date Issued: Wednesday, January 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20070426
has been completed.
Tax Map Number 523400-295-006-0001-016-000-0000
Location: 1162 WEST MT. Rd
Owner. WILLIAM & CHERYL NOLIN
Applicant: WILLIAM & CHERYL NOLIN
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&Co nfo ent
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: P20070426 Application Number. A20070426
Tax Map No: 523400-295-006-0001-016-000-0000
Permission is hereby granted to: WILLIAM &CHERYL NOLIN
For property located at: 1162 WEST MT. Rd
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: WILLIAM &CHERYL NOLIN
Septic Alteration Residential
1162 WEST MT. Rd
QUEENSBURY,NY 12804 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
JAMES &ROSEMARY WALKER
P.O. BOX 543
GLENS FALLS,NY 12801-0000
Plans &Specifications
2007-426
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,July 11, 2008
(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 bu f�d n tJuly 11,2007
V for the Town of Queensbury.
SIGNED BY � ury•
Director of Building&Code Enforcement
Irsrs rr rrssrr.r__rrrr_rr,.rrrrrrrrr_rrrrr►►rrrrrr.srr rss►r rrr►srr►__r r _►► ►r►►►rr►.r r_s.�
Jl- /� OFFICE USE ONLY
"ZRMITFEE
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TAX MAP NO. PERMITN0. —
0 APPROVALS: ZONING TOWN CLERK ;
-►___r_____r __..___.._r__rr._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: 4?.. � � 1 � INSTALLER: �aELcs e7� LL)C�e r
ADDRESS: t�(D 2- L.�V• Mom_ ADDRESS R) 5q-3 I' G'� 2 �j
PHONE NOS. --I PHONE NOS. 0- 10S 0
LOCATION OF INSTALLATION: , tD2- `� {G`L� V 8
.....................................ww, ...............................................,......,......,..............,......................................................................; .........,...............................................I.............= RESIDENCE INFORMATION.
NO.OF
YEAR BUILT i X COMPUTATION= = TOTAL DAILY FLOW
i i i
} BEDROOMS i i
s..................................I....... .........................................................,..........................................,..........................................;.......»........,........................................................; GARBAGE GRINDF (,
i 1980 or older r./ X 15o gallon per bedroom i _ /� i INSTALLED?
1...................w..w...»....w............l.............,...............................I...........i..........,........................................................... .1 .'....L.............. ................................•.•...............
I 1981 -1991 1 '_. X 1 130 gallon per bedroom _ SPA OR HOT TUB
..._ ............ ..;..............................................i•..........j..................I......................., '....
1992 present , .': X 110 gallon per bedroom _ ...............................t INSTALLED?
f
1..............w��.�.Z.w................73...........................r............,..........................................................................,......................................................................................
;
PARCEL INFORMATION: /
✓ TOPOGRAPHY: FLAT y STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND \"" LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT 00
WHAT DEPTH? ` /
✓ DOMESTIC WATER SUPLY: MUNICIPAL ' WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS ("<- PER 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 TANK: I I5Q GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH L FT.t
✓ TOTAL SYSTEM LENGTH:AFT. SEEPAGE PIT(S): HOW MANY? `Ik kz✓
✓ SIZE OF EACH FT. X FT. 04, Su &Zry
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH ANDIOR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
I,:•:.....:.:...................:.,.:.:........:.:.:.:•:.:.:.:.:.:.:•:•:.:...........:.:.:.;.:.:.:.:.,.,.:.:.:.:.:.:.:.:.:.,.:.:.:.:.:.:.:.,.:.:.:.:.:.:.:.:.:.:.,.:.:.:.:.:.:.............:.:.:.:.,.;.:.:.:.:.:.::.:.:.:.:•:.,.:.:...................:.:...........:.:.............................................:.:.............:...........
:.:.�
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
IS APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. (i
.:::,:..,:>:,.:>.:.:,:.,.:..::.:::.:::.:..::..::::::::...:....::::.:.:::::..:.::.::.::.::::::::::::::.:::....:...:.:..:.::::::..::.:::.::::.::.::::::::::::::::::....::.:.:::::,::.:,
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 b these and all requirements of the Town ofCOUESTIONS? CALL 761-8256 OR EMAIL
9 Y q codes�uueensnurv.nQueensbury Sanitary Sewage Disposal Ordinance. IT OUR WESSITE FOR MORE INFORMATION
�� www.aueensburv.net
Signature of Pe Responsible Date
Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury,NY 12804
/ -3 'A(t-)r-3dA,V
r. --?
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ,
NAME: U Cif PERMIT NO.: - Z6
LOCATION: INSPECT ON:
RECHECK: I t-
Sol!T
Comments and/or diagram
n C!a
-Typeof Wa er: un Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells ft,
Absorption Field: Total lengthft,
Legg1h of each trench ft,
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
-Building to tank 4-1-
Tank to Distribution Box R
Distribution Box tvftld Pit
Openi Sealed:ft Al Partial
End Ca
Inlet/Outlet Pipes&Baffles I IU—N
Location Separations
Foundation to tank ft.
Foundation to absorptioe it '`ft
Separation of Pits ft.
Conforms asr Plot Plan Y N
Engineer Report
rt and As-Built Y N
Location of Sy n Property:
Front Rear ft Side Right Side
Middle Front Middle Rear
Sy$temUsew zs
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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