2011-340 ' r^ 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:, P20110340 Date Issued: Friday, July 22, 2011
This is to certify that work requested to be done as shown by Permit Number P20110340
has been completed.
Tax Map Number: 523406-295-014-0002-068-000-0000
Location: 36 MT. VIEW Ln
Owner: JILL M HUNT
Applicant: JILL M HUNT
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&69 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: P20110340 Application Number: A20110340
Tax Map No: 523400-295-014-0002-068-000-0000
Permission is hereby granted to: JILL M HUNT
For property located at: 36 MT. VIEW Ln
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. T_we of Construction Value
Owner Address: JELL M HUNT Septic Alteration Residential
36 MT. VIEW Ln Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-340
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 14,2012
(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 n-oflQueens ry; ur`sday July-14,2011
SIGNED BY c l��rR�' ' Gti':' for the Town of Queensbury
IV.-.
Director of Building&Code Enforcement
/1
OFFICE USE ONLY f
TAX MAP NO. PERMIT NO. RMIT FEE JUL 13 2011 lu
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERM! T6VVNBUILDING
D NG&CODES
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS FORE
ISSUANCE OOFF A/VALID PERMIT. 11
OWNER: c ( c/ �"� 7 INSTALLER:
ADDRESS: p c/��/b,4/LI/��.c ADDRESS: r Q/l L�
PHONE NOS.3d 2- PHONE NOS. /
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980orolder X 150 = INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLI STEEP SLOPE`� %SLOPE/
✓ SOIL NATURE: SAND LOAM AA CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? !! `'
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH
✓ DOMESTIC WATER SUPLY: MUNICIPAL WE (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi]
(Test to be cbrripleted 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: 0&6. GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for C-e'l
each garbage grinder,spa or whirlpool tub.
SYSTEM PE:
ABSORPTION FIELD(WITH NO.2 STONE) Total length 2AC ft. Each trench J X i)
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? A4 Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑HOLDING TANK SYSTEM Total required capacity? �T..kksre? 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 Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewa Disposal Ordinance. codes(aDaueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
tgnature of Person Responsible ate www."—I & 44(
gueensburv.net
Town of Queensbury* Community Development Office*742.Bay Road, Queensbury NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart:1j, am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: I
NAME: l ll PERMIT NO.. ' — 3D
LOCATION: l �! INSPECT ON: 7 s -211
RECHECK: If
Comments and/or diagram
Soil Type: Loam/ Clay
Type of Water: u . . I/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/ - Y N N/A
150'to well r uired if NO
Absorption Field: Total length
Length of each trench ft.
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: fx
Stone Size:
Piping Size Type
Building to tank 'L—V! � NA
Tank to Distribution Box `� 1? -
Distribution Box to Field/ Pit L -71
Opening Sealed: Y_N
End Ca _kY_N
Inlet/Outlet Pipes&Baffles _J&Y
Manholes 12"or less below grade Y
[provide extension collar if Yes Y ZK
Location/Separations
Foundation to tank v ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan 1v _N
EA9#1e@=Rj3PW and As-Built Y_N
ETU Maintenance Contract Y_ N
provided
Location of Syste Property:
Front Rear Left Side Right Side Middle Front Middle Rear
Ss
tem Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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