2013-134 I 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: P20130134 Date Issued: Wednesday, April 10, 2013
This is to certify that work requested to be done as shown by Permit Number P20130134
has been completed.
Tax Map Number: 523400-295-018-0002-017-000-0000
Location: 10 CROWNWOOD Ln
Owner: JOHN & ELIZABETH DAVIS
Applicant:
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 Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 128045902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130134 Application Number: A20130134
Tax Map No: 523400-295-018-0002-017-000-0000
Permission is hereby granted to:
For property located at: 10 CROWNWOOD 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. Type of Construction Value
Owner Address: JOHN &ELIZABETH DAVIS Septic Alteration Residential
10 CROWNWOOD Ln Total Value
QUEENSBURY,N.Y. 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2013-134
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,April 09,2014
of 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 o uee bury; Tue + .y t i ril 09, 2013
SIGNED BY ,- t for the Town of Queensbury.
Director of Building&Code Enforcement
a
Community Development Office APR G8 2013 ,
Town of Queensbury • 742 Bay Road - Queensbury, New York •12804 1 /
Office Use Only /� p (/ r
TAX MAP NO. n� 1�•\ - a.--) 7 PERMIT NO. I3- ) 3 j PERMIT FEE 1 t
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM jERMIT: A PERMIT MUST BE OBTAINED
BEFORE
�7WORK_BEGINS.APPLICATION IS SUBJECT TO REVIEW c 7 ORE ISSUANCE 0 £V ERMIT.
OWNER: v 1 N -_PAvi / _r INSTALLER. &_ t- _.ei..0 �2 tc
ADDRESS:LO p ( c WO J1 LA-0E- ADDRESS: P-7✓ 7 00X� rart ! 6 F _
PHONE NOS. _/ Of_' 3-0 I /J _ PHONE NOS. / 9 0 -o J O _
LOCATION OF INSTALLATION:JO C2oc I wh z7
YEAR BUILT NO.OF X COMPUTATION RESIDENCE INFORMATION:
BEDROOMS (Gallons per bedroom) = TOTAL DAILY FLOW GARBAGE GRINDER
1980 or older 171 X 150 = I ,t 0 0 INSTALLED?_
1981 -1991 / X 130 = SPA OR HOT TUB N o
1992-present I X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLL! STEEP SLOPE_ %SLOPE_
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: ATW HH jT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPALy WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpg (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 SIZEt O _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: .S / r
cieABSORPTION FIELD(WITH NO. 2 STONE) Total length 1 S0 ft. Each trench . " _X
o SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
o ALTERNATIVE SYSTEM Bed or other type?
o 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.
1 •- -d the re;u r: 'ons with resp- t to this application and agree to
ab e by ese . d :II =.uiremen =/Jf the Town of ueeQy sbury QUESTIONS? CALL 761-8256 OR EMAIL
\ Snits Sewa:-- o .p'�IOrdi ,:/re.— // / codesCdqueensburv.net
- - ure of Perso 'esponsible Date / VISIT OUR WEBSITE FOR MORE INFORMATION
www.oueensburv.net
la
Septic Inspection Report
Office No. (518) 761-8256 Date In pection >•..�- eived:
Queensbury Building &Code Enforcement Arrive: i• tf4,�,�.• 1. ..rt: a am/ nC,
742 Bay Rd., Queensbury, NY 12804 Inspector's Inib. .
NAME: :-J-i) il\ t ,auj& PERMIT NO.: 13 -I 31
LOCATION: /0 INSPECT ON: Ad- /O -1 3
RECHECK:
Comments and/or diagram
Soil Ty�m/clay
Type of Water•
noel
Water
Water me separation distance 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 71rO ft.
Length of each trench ,6-,.-a t.
Depth of trenches Z- •'2 ft.
Size of Stonez_
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank y It Q.} C_
Tank to Distribution Box L `% /It> - 3.h ,�
Distribution Box to Field/ Pit `` 41( 69(2-3 h TD y bt?-35 ?CIF-
Opening Sealed: ✓Y N
End Cap N
Inlet/Outlet Pipes&Baffles V N
Manholes 12"or less below grade ✓Y— N
[provide extension collar if Yes] _Y_ N
Location/ Separations
Foundation to tank Un ft.
Foundation to absorption 7 0_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 0 Left Side _lar Middle Front Middle Rea
tern Use Sta :
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
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