2012-024 TOWN OF QUEENSBURY
r742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120024 Date Issued: Thursday, July 11, 2013
This is to certify that work requested to be done as shown by Permit Number P20120024
has been completed.
Tax Map Number: 523400-296-015-0001-012-000-0000
Location: 51 COUNTRY CLUB Rd
Owner: THOMAS & JOSETTE KILL
Applicant: THOMAS & JOSETTE KILL
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&Code force nt
Planning Board or Zoning Board of Appeals.
01.14
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
431
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120024 Application Number: A20120024
Tax Map No: 523400-296-015-0001-012-000-0000
Permission is hereby granted to: THOMAS & JOSETTE KILL
For property located at: 51 COUNTRY CLUB 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: THOMAS &JOSETTE KILL Septic Alteration Residential
51 COUNTRY CLUB Rd Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
STACEY SCHRAUER
NY 12804-0000
Plans&Specifications
BP 2012-024
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,January 24, 2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury;� //Tuesday,-January 24, 2012
'> _I/' /1 %� F �
SIGNED BY ' for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/201 C
OFFICE USE ONLY "N ; `�4/1
N .).e I)--�� J�-�.I.. .. .} 2ij J,
c2_ 60. / s .--/ - /,,2- lECIEOVIE -;\
TAX MAP NO. PERMIT NO. PERMIT FEE },
OWN 0�'I.fUEENSBURY
• APPROVALS: ZONING TOWN CLERK BUILDING&CODES
•• APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID� PERMIT. ,` c
OWNER: j031-14-4 (2.0II I INSTALLER: S/(6`(.,`l JC/'li�t+�`
1 t5b
ADDRESS: 51 Coo. (.1 LIIh tact,QsbyADDRESS: `7J ().•4N 3 C/k4 i6✓` 4)1keesI74f N 11,
PHONE NOS. `h ) 1 1/41 -- I‘5 l PHONE NOS. H110,41e "N3-//$r Cc// 30-3,0 6 /Zro '
LOCATION OF INSTALLATION: L>1 CO LA-Ain C I 4--1_167 red I C) J 19I
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older 'Z X 150 = o INSTALLED? tW O
1981 -1991 Z X 130 = SPA OR HOT TU,�
1992-present Z X 110 = I - INSTALLED? I V L1
PARCEL INFORMATION:
r
✓ TOPOGRAPHY: FLAT ROLLING ,)` STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND X LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? /V—i
lf-
✓ BEDROCK/IMPERVIOUS MATERIAL AT WHAT DEPTH? P/1
✓ DOMESTIC WATER SUPLY: MUNICIPAL /` WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mph]
(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).
TANK SIZE: (.60 0 GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE: �"
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length /50 ft. Each trench -2- J x 0
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? /v/4. Size?
ID ALTERNATIVE SYSTEM Bed or other type?
o HOLDING TANK SYSTEM Total required capacity? IL)OO Tank size? 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 Sewage Disposal Ordinance. codes(a?queensburv.net
L J VISIT OUR WEBSITE FOR MORE INFORMATION
n re of Person Responsible Date www.aueensburv.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
Septic Inspection Repo
Office No. (518) 761-8256 Date Ins.- ion ' ed:
Queensbury Building & Code Enforcement Arrive: , '41i , au4 .ce
'epart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial 1 -PNAME: I !`c 1Nr�(-4 i\ �,e( PE'/
IT NO.: / ,)-'n' `'
LOCATION: ,-1 imoi` iti -i c 6 . ,�?,-,� Rd I :PECT ON: -j -1 1-i
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loam/ Clay
Type of Water: Municipal / Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft. �, irt
Well Casing Length 50' + / - Y N N/A U I LT
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone v
Seepage Pits: Number 'S
Size: x °v
Stone Size: s ✓
Piping Size Type / . ' _
Building to tank t�TT t�_.,�
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Cap _Y_ N \ Voy-CA'lc
Inlet/Outlet Pipes&Baffles _Y N
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] _Y— N V
Location / Separations .0 1 kO '1.--: '6F
Foundation to tank ftp ��` -�-
Foundation to absorption _ -? -0 R c'
Separation of Pits ft. V J
Conforms as per Plo iae- — N N
Engineer Report and .sem i Y N
ETU Maintenance Contract _Y_ N
1 provided --
A \v x
/
Location of System on Property: �/
Front ear Left Side Right Side Middle Front Middle Rear CO 0 1C2,-'-k CA-0V7
S stem Use S tus:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Ins•- :op �ed:
Queensbury Building &Code Enforcement •
Arrive: = -:.rt: 'rr /742 Bay Rd., Queensbury, NY 12804 Inspector's In'.• n _-- - -
/ r`
NAME: 1'l 1 a— � PERMIT NO.: I z-(32_(32_Lk
LOCATION: N5 i Col l b1/4).---{ tom`( C LOB NSPECT ON: S 251-I Z
RECHECK:
Comments and/or diagram
Soil Ty.,-_. ...:.:„. •-•• / Clay
T .- of Water: �., ell Water
Waterline`' o distance I, l') ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + /- Y N N/A
[150'to well required if NO]
Absorption Field: Total length 1 totem ft.
Length of each trench z 4' W.-10t.
Depth of trenches 71 ye•'ft.
Size of Stone i #JFjL:T9.11/4A- -�.
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank Li i t l-{0
Tank to Distribution Box Li U 1,. r ±e_....±4..... V
Distribution Box to Field/ Pit #1 /-)(")D 3
>
Opening Sealed: / N
End Cap ____ii,z___
Inlet/Outlet Pipes&Baffles ___Izt . N
Manholes 12"or less below grade ;✓Y N
[provide extension collar if Yes] --__Y
Location/ Separations
Foundation to tankft.
Foundation to absorption 7' ft.
Separation of Pits
Conforms as per Plot Plan � fY N
uT
Engineer Report and As-Built N ---- k1D ._
ETU Maintenance Contract Y_ N
provided ---- .,..----..__-_---
Location of System on Property:
Frontes Ria `wft Side Right Side Middle Front Middle Rear
System�Use—status:
Approved
Partial Approved and needs to be re-Inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Forms\Septic Inspection Repori`03 29 10.doc