2012-351 ,._44111% TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120351 Date Issued: Wednesday, August 01, 2012
This is to certify that work requested to be done as shown by Permit Number P20120351
has been completed.
Location: 33 COTTAGE HILL Rd
Tax Map Number: 523400-301-008-0002-021-000-0000
Owner: LINDA MASON
Applicant: LINDA MASON
This structure may be occupied as a:
Septic Alteration Residential By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property
owner of the responsibility for compliance with Site Plan, Variance, or (P7)
other issues and conditions as a result of approvals by the Planning Board {
Director o Building& ode ' •. ".rc 4;ent
or Zoning Board of Appeals.
- A./4 - TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
~ Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120351 Application Number: A20120351.
Tax Map No: 523400-301-008-0002-021-000-0000
Permission is hereby granted to: LINDA MASON
For property located at: 33 COTTAGE HILL 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: LINDA MASON Septic Alteration Residential
33 COTTAGE HILL Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2012-351
Rcs. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 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 Tow of Que sbu ; J� 24,2012
vet/
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
JUL 242012
r Community Development Office
.
-` Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only I 1 dv
TAX MAP NO_3at .0 p— �.`a l PERMIT NO./ 35 1 PERMIT FEE46 l
APPROVALS: ZONING TOWN CLERK _
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST RE OBTAINED
BEFORE ORK BEGINS.APP.LI A�_TION IS SUBJECT TO REVIEW ORE ISSUANCE 07-AVALID/PERMIT.
OWNER: // kJ A s o /4 INSTALLER: , !L� U QGcl c I
ADDRESS: ry) 3 Co rip1" .� 141 IJ ADDRESS: 0 ?OX L - ' 6 F _
PHONE NOS. /0? tn.-
) 7 PHONE NOS. 7 9 C.— 0 Pcr.
v
LOCATION OF INSTALLATION: 33 i' I .// i--)
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
_
BEDROOMS (Gallons per bedroom) GARBAGE GRIN
XTD
1980 or older Z X 150 = �a 0 INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUBIL/ 6
1992-present X 110 = INSTALLED? '"
PARCEL INFORMATION:
I TOPOGRAPHY: FLAT ROLLIN STEEP SLOPE %SLOPE
I SOIL NATURE: SAND = LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT,EPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL 1.7 WELL__(If well:water supply from any septic system absorption is: ft)
I PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpij (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:1 0 00 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:
El ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
❑SEEPAGE PIT(S) (WITH NO. 3 STONE) How man ? Size? _
ALTERNATIVE SYSTEM Bed or other type? eAJ f _
❑ HOLDING TANK SYSTEM Total required capacity? 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 e r .• •- -• ations with respect to this application and agree to
a ide y t - - a : al require nts of the Town of ueenstlury QUESTIONS? CALL 761-8256 OR EMAIL
ni ry S.-#000.11• Di •osal once. `// codes(o�queensbury.net
7 2-Y
Dnair-ref -- on .esponsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
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53
Septic Inspection Re * -0S
• . '
Office No. (518) 761-8256 Date Inspection requ, -' ••:
Queensbury Building &Code Enforcement Arrive: a /�
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 1►1�
Ut D
NAME: �.� . 1. _ ri" .e.'t '.• , NO.: et..*)D1',
LOCATION: *. • a Mal I 'ECT ON: –1(o—
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water -
�w
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO] 1
-Z–LF E_Te-fv_LALN CiENU
Absorption Field: Total length ft. --�
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: _Y N
End Cap TY N
Inlet/Outlet Pipes &Baffles .�Y N
Manholes 12"or less below grade _Y_ N
[provide extension collar if Yes] Y— N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y,•,�N
Engineer Report and As-Built —Y N
ETU Maintenance Contract Y_ N
provided
Location of System on Property:
Front Rear Left 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 Report03 29 10.doc
( gym
Septic Inspection Repo.
Office No. (518) 761-8256 Date Ins co3on req -
Queensbury Building &Code Enforcement Arrive: � ;h a '1 ?epart:
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials. 17.
NAME: - tif91, ilk ,.A i, PE• IT NO.: I 1
LOCATION: `3 3 - • . 4+--( I PECT ON: '7 *: -/
RECHECK: l
Comments and/or diagram
Soil Typ-. .r%di oam / Clay
Type of Water: unicipal v, - Water
Water • -.aration distance FQr,3V 449,C)ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + /- Y N N/A
Absorption Field: Total length t-4f) ft.
Length of each trench l eQ 20ft.
Depth of trenches 7-.)-1 ` ft.
Size of Stone f .o►JC 2F vc ,h1
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tankp h GFS 0
Tank to Distribution Box L Aj 0,
Distribution Box to Field/ Pit /� t.- ' ' .0 L1"OO Vic T� E
Opening Sealed: tel' N
End Cap N
Inlet/Outlet Pipes &Baffles Y N
Location/ Separations
• Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits l ft.
Conforms as per Plot Plan V Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front MI Left Side Right Side Middle Front Middle Rear
S ei U - .L .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
Community Development Office
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— Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
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