2015-107 TOWN OF QUEENSBURY
vro742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150107 Date Issued: Wednesday, April 29, 2015
This is to certify that work requested to be done as shown by Permit Number P20150107
has been completed.
Tax Map Number: 523400-302-014-0002-056-000-0000
Location: 13 BULLARD Ave
Owner: ROBERT & CATHERINE MC NULLY
Applicant: ROBERT & CATHERINE MC NULLY
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 ( a4.P 4 , -
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&Code E ,tcem n
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
coro 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150107 Application Number: A20150107
Tax Map No: 523400-302-014-0002-056-000-0000
Permission is hereby granted to: ROBERT& CATHERINE MC NULLY
For property located at: 13 BULLARD 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: ROBERT& CATHERINE MC NULL'
13 BULLARD Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-107
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 22,2016
(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 T n of een % /• s ,y, April 22,2015
4
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT
Office Use Only
DATE i ? I 1 3 I E Received , '-')
Tax Map 16
TAX MAP ID lil Permit No. 2.015 / tb1-
A I 1 APR 2 IP ii Fe- ito./- - ��
LOCATION OF INSTALLATION /3 Aca."1,41--J- 4,•t • ,Is: f
•WNOFQ E SBURY
� nVd, / =UIL.DING& CODES
APPLICANT (2/A )''`1 e/°eve Ac/ �� PHONE/E-MAIL
ADDRESS J3 &id-- /9--P-
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INSTALLER/BUILDER: ,HJT/vvi /I-A / S.-iv-eV SIV/c r PHONE/E-MAIL
ADDRESS: '.: 6e Z?
OWNER (" 44-1- c / /`'"P /17C Ala-4--- PHONE/E-MAIL
Address /3 og411. -r,---1 -e
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: e® (_ 1). 1•0_,-gS PHONE r,(� ,576
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older /5-0(> f, f,` Garbage grinder installed _Y X N
1981-1991 Spa or Hot Tub installed Y KN
1992-Present
PARCEL INFORMATION
Topography X__Flat rolling Steep slope %slope
Soil Nature X Sand Loam Clay Other
Groundwater At what depth? /✓4
Bedrock/Impervious Material At what depth? •4f!‘i-
Domestic Water Supply T Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: /— per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size /43Z, gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length.72C0 ft.; Each trench `1S x -5--
Seepage
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system& associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received &approved. The installed system must match the septic system
layout on file—no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations and
agree to abide by tiygse and all req erne f the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: ( -'� e G - Date: `r' - Z Z -f r
Signature: � Date: c,/,— 2/ - , 1'
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
Town of Queensbury Building & Code Enforcement tltS
Office No. (518) 761-8256 A l
Septic Inspection Report
Inspection request received: 1 912 -1 1
Name: Mc.O `A Inspected on: g\7.45
Location: I'J11cwd Arrive: st'A a.m.l p.m.
Permit No.: 1 S - )0'r- Inspector's Initials: ,b
Comments and/or diagram
Soil Type: Sand I Clay
Type of WaterCM nni ' al/Well Water
Waterline separation distance ft.
Well separation distance
Other wells: ft.
Well Casing Length 50'+I- Y N N/A
[150'to well required if NO]
Absorption Field: Total length 7-00 ft.
Length of each trench ft.
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: f x�/
Stone Size:
Piping Size Type
Building to tank C1C.1 '-51 -
Tank to Distribution Box (k
Distribution Box to Field/Pit ,`<<
Opening Sealed: N a o y
End Cap N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade Y N
[provide extension collar if Yes] Y N
Location/Separations Or
Foundation to tank l r ft.
Foundation to absorption 1,r7'rft.
Separation of Pits
Conforms as per Plot Plan Y N
Engineer Report a s uilt N /f rJ
ETU Maintenance Contract provided Y N ,
Location of S ste _•n Pro ye :
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Statu •
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
lit)1
Septic Inspection Report
SEPTI PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
I SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
MEA U ED THE DISTANC ET FO T ON THIS DIAGRAM.
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i IGNATU6RE DATE
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,� _ APR 21 2015
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TOWN OF QUEENSBURY
BUILDING& CODES