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2007-431 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 (zt Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20070431 Date Issued: Wednesday, January 09, 2008 This is to certify that work requested to be done as shown by Permit Number P20070431 has been completed. Tax Map Number. 523400-289-007-0002-019-000-0000 Location: 3 NOTTINGHAM Dr Owner. RICHARD & CYNTHIA ELLINGER SR Applicant: RICHARD & CYNTHIA ELLINGER SR 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 (�2)j 00t property owner of the responsibility for compliance with Site Plan, VVV 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. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20070431 Application Number. A20070431 Tax Map No: 523400-289-007-0002-019-000-0000 Permission is hereby granted to: RICHARD & CYNTHIA ELLINGER SR For property located at: 3 NOTTINGHAM 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: RICHARD &CYNTHIA ELLINGER Septic Alteration Residential 3 NOTTINGHAM Dr Total value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2007-431 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,July 12, 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 Towr(of Qu bu IV T s 1Y 12 2007 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement r �..... ... ... ............................... ,�'; -(q OFFICE USE ONLY '. 0 00 , ; , 0 TAX MAP NO. PERMIT NO. PERMIT FEE 2�` APPROVALS: ZONING _ TOWN CLERK 0 ............................................... +. ,..._.. .,. r .... APPLICATION FOR SEPTIC DISPOSAL SYSTEM MINT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: �L ��\{�q st INSTALLER: \AJ C t V s� yY ADDRESS: `� fJ c�Cv ti@V ADDRESS: 3 L -tS PHONE NOS. ` !! PHONE NOS. q LOCATION OF INSTALLATION: l (�-- ............................................�.................................... ...................I..........tMPUTATION= ..........................................._..... j...................................................................... { ••• ••: RESIDENCE INFORMATION: NO.YEAR BUILT BEDR OF S X i ( _ `. TOTAL DAILY FLOW 1..............................................Y......._....`.. .......... t a ..............................,......; GARBAGE GRINDER 1980 or older ! 3 i X 150 gallon per bedroom } �/ �U '-_17� = i S INSTALLED. }..._.................._.........................,........................................{..........t.........................................................................{...........i..........................................................................; 1981 -1991 s X i 130 gallon per bedroom SPA OR HOT TUB ..................................................................................,............,....,............................,....................................................................,..................................................................; 1992 present I X 110 gallon per bedroom - ! INSTALLED? ....................................._.......i............................................_i............t.................................._......_.................... t. s ...-...............................................................................: PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING / STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND V LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL Z (IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. ) ✓ PERCOLATION TEST: RATE IS l 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: GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH J'G FT. / ✓ TOTAL SYSTEM LENGTH: 110 FT. SEEPAGE PIT(S): HOW MANY? ✓ SIZE OF EACH FT. X FT. ✓ SIZE OF STONE TO BE USED: !DEPTH OR THICKNESS FT. ✓ BED SYSTEM SIZE: —r U h— ✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE ✓ HOLDING TANK SYSTEM:(If require NO. OF TANKS: /SIZE OF EACH ✓ GALLONS./TOTAL CAPACITY: GAL. NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. i F::.......................................:.............:..:.:...:.,...,.,.,.,.:...,.,.,.:.....,.....,.,.....:.....,...,.:.,.:.,.,.,...,.,.,...,.,.,.:.:.,.,.,.,.,.,...,.,.,.,.....,.,.:.,.,.,..,..,.:...,.,.,.,.,.,.,.,.,...:.,,....:.,.,.,.,.,.,.,.,.:.:.,...,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,...,.,.,.,...,.,.:.,.,.,.,.,.,.,.,.,.,.:.,.,.,.,.,.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 ? CALL 781-9256 OR EMAILagree to abide by these and all requirements of the Town ofcodes®aueensbury netQueensbury Sanitary Sewage Disposal Ordinance. CQUESTIONS IT OUR WEBSITE FOR MORE INFORMATION _. www.aueensburV.net Signature of Person Responsible Date Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury,NY 12804 4 z \=- Jon r yy 4� e_3 Septic Inspection Report Office No. (518) 761-8256 Date Inspeca n request received: Queensbury Building&Code Enforcement Arrive: ' o am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: iQ� ' 1 NAME: � PERMIT NO.: LOCATION: INSPECT ON: RECHECK: Comments and/or diagram Sal T : Sand Loam Clay Type of Water: Municipal Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft, Absorption Field: Total lengthft• ,��s Length of each trench Depth of trenches Size of Stone Seeoge Pits: Number Size: x Stone Size: Piping Size Type Building to tank Z-1 Tank to Distribution Box Distribution Box ieid Pit lox 0 nin Sealed' Y N Partial (� End Ca In Outlet Pipes&Baffles Y N Location Se rations Foundation to tank ft. Foundation to absorption ft. �f Separation of Pits ft. Conforms as per Plot Plan 17Y N Engineer Report and As-Built I Y N Location of System on Property: Front 0;� Left Side Right Side Middle Front Middle Rear i Sy-!&m Use S s: _ Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Last revised 021006 Cr ` �� i` Last revised 1/6/05 .huinger rugc 1 �l 1 Ellinger D7 �31 259:7.2�1 U-� S t� Av ,1 s Scalsbar length always=349feet The Town of Queensbury does not warrant the correctness or accuracy of this data or assume any responsibility for any explicit or implied uses. Town of Queensbury 742 Bay Road Queensbury,NY. 12804-5902 http://gby2svr/GIS/printdis.asp 7/11/2007