2014-093 o� ` 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: P20140093 Date Issued: Tuesday, April 08, 2014
This is to certify that work requested to be done as shown by Permit Number P20140093
has been completed.
Tax Map Number: 523400-301-006-0001-008-000-0000
Location: 2 VAN Ct
Owner: ROBERT & MARY SEARS
Applicant: ROBERT & MARY SEARS
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
04: •
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 Enforcement
Planning Board or Zoning Board of Appeals.
i! yn TOWN OF QUEENSBURY
` � 742 Bay Road,Qucensburr,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140093 Application Number: A20140093
Tax Map No: 523400-301-006-0001-008-000-0000
Permission is hereby granted to: ROBERT& MARY SEARS
For property located at: 2 VAN Ct
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&MARY SEARS Septic Alteration Residential
HEATHER FAIR-SEARS Total Value
2 VAN Ct
QUEENSBURY,NY 12804
Contractor or Builders Name /Address Electrical Inspection Agency
Plans&Specifications
2014-093
Res. Septic Alteration
540.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, April 04,2015
(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 Que sbury Fri , , y pril 04,2014
SIGNED BY 4.\ for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Building & Codes Received:
SEPTIC DISPOSAL PERMIT Tax Map ID: SOI• (O' I g
Permit No.: I'''- 09,3
A permit must be obtained before beginning construction Permit Fee: $ 912 a
Lc. Approvals:
Applicant: NV-Ito s F d -3, Lc, InstallerBuilder N DcL%q ( -- •
Address: 019n-7 itecc.co' Address Z c-s' Pe-- PD
G1 Sc g asio-e. -e
Phone: '79 L — to crcg'1 Phone 746 — &cc Z-/
Owner: b Location of Installation
Address: 2 -tIe.O Co`....4-rte"
Phone 74.2— l'f34
Contact Person for Building&Code Compliance: Day Phone:
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
der x 150 = Garbage Grinder installed? JO
1981-1991 .3 x 130 = Spa or Hot Tub Installed? fin
1992—Present x 110
Parcel Information:
Topography Flat Rolling _Steep Slope %Slope
Soil Nature Sand Loam Clay _Other
Groundwater At what depth?
Bedrodcllmpervious Material At what depth?
Domestic Water Supply 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 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 gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage' grinder,spa or whirlpool tub
ft `l
System Type: Absorption Field(with#2 stone) Total length ZOO+
. Each trench X 4-
Seepage Pit(S)(with#3 stone) How many? Size?
Altemative System Bed or other type?
Holding Tank System Total required capacity? Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. There will be no exceptions.
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 Sanitary
Sewage Disposal Ordinance.
Print Name: .c- 4:S yG Date: y/'/20/y
Signature: Date:
Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256
rreid
f Queensbury Building &Code Enforcement y pm
- Office No. (518) 761-8256
Septic Inspection Report AS BUILT
Inspection request received:
Name: 3 ioS c2l? r-g Inspected on: -4-1-1
Location•:_ kJ V0,0 ear r+ Arrive: , ;'....+1;'....+1 APP. .1 p.
Permit No.: 14
/ —(05'3 Inspector's Initials: sir
Co r-nts and/or dia.ram
Soil Type • Loam/Clay
Type of Wate . Municipal/Well Water
Waterline separation distance If) 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 ft.
Length of each trench /1 eft.
Depth of trenches _7<_17 ft.
Size of Stone 5=C17 _
Seepage Pits Number !/
Size. x
Stone Size:
Piping Size Type
Building to tank Ly, 6c—sr (-Air e:- - y v L
Tank to Distribution Box 9-'r �
Distribution Box to Field/Pit / r ;50--35---r- 41' !�1)V—WL 94
Opening Sealed: 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
Foundation to tankft.
Foundation to absorption (ft.
Separation of Pits 7- ft.
Conforms as per Plot-Plan v Y/ N
Engineer Repo nd As- t Y N
ETU Maintenance ontract provided _Y_N
S
Location of _seu. on Prose :
rout •e Left Side Right Side Middle Front Middle Rear
S stem Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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