2013-111 TOWN OFQUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130111 Date Issued: Monday, April 08, 2013
This is to certify that work requested to be done as shown by Permit Number P20130111
has been completed.
Tax Map Number: 523400-295-014-0002-041-000-0000
Location: 35 CROWNWOOD Ln
Owner: JOHN & MARYELLEN SCHURGA
Applicant: JOHN & MARYELLEN SCHURGA
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 (-3J14 k—
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.
0.k4 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130111 Application Number: a20130111
Tax Map No: 523400-295-014-0002-041-000-0000
Permission is hereby granted to: JOHN & MARYELLEN SCHURGA
For property located at: 35 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 & MARYELLEN SCHURGA
35 CROWNWOOD Ln Septic Alteration Residential
QUEENSBURY,N.Y. 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY.NY 12804
Plans&Specifications
2013-111
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,April 03, 2014
(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 uee sbury AWe s f y,As HI 03, 2013
Air
SIGNED BY �Q( for the Town of Queensbury.
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Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
ANr; 0 3 2013
Office Use Only p (
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TAX MAP NO. D6i 6, 14 -D.--- ! PERMIT NO. / 3 'd' / / PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFOREFISSUANCE OF A VALID PERMIT.
OWNER: (}I,Ne. SC l e rc,f 1r INSTALLER: IQ J ` . ' (I)-4
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ADDRESS: 5 Crow rW00V) ADDRESS:4 l L n�wPr\/V,r('Qi^S1" . £.:�
PHONE NOS. 7 J �� 61 PHONE NOS. 1 CA— 19
LOCATION OF INSTALLATION: �j c C (QW Y` �+V y th
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRI `D R
1980 or older X 150 = (41 0 INSTALLED?
1981 -1991 1'C X 130 = N SPA OR HOT TON.
1992-present \ X 110 = IVA-- INSTALLED? IV 1t
PARCEL INFORMATION: / `r
•1 TOPOGRAPHY: FLAT RO LING V STEEP SLOPE N %aSLOPE 1f
�J N
✓ SOIL NATURE: SAND LOAM y V CLAYNr OTHER`
44 IM
✓ GROUNDWATER: AT WHAT DEPTH? I v
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? \V �, I J
v'' DOMESTIC WATER SUPLY: MUNICIPAL
/ WELL 1U ik(If well:water supply from any septic system absorption is: 4U ( ft)
✓ PERCOLATION TEST: RATE IS : I } PER MIINUTE PER INCH[mpi] (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: Ir Ctn 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 \-QC) ft. Each trench X 3
❑ SEEPAGE PIT(S) Ar(WITH NO. 3 STONE) How many? IV il\ Size?
o ALTERNATIVE SYSTEM Bed or other type? N
❑ HOLDING TANK SYSTEM Total required capacity? 1v.rN Tank size? \ (IN Number of tanks?
0_
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 osalOrdinance. I codes(c�aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Signat re o Pe n Responsible Date www.queensburV.net
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection reque7 z?''v-••
Queensbury Building & Code Enforcement Arrive: �'— "10, ,elp,.r-•:rt: =!`i1 am()
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: i
NAME: S` }�.QA • RMIT NO.: / 3—///
LOCATION: 3 C INSPECT ON: 4-/-41-/3
RECHECK: Q s
Comments and/or diagram
Soil Ty.-• 1_1,- oam / Clay
Type of Water • unici... Well Water �1
Water i - -•. - ion distanceotil -,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 6�w mit.
Depth of trenches 2-- _ ft.
Size of Stone '7_
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank c►r('i� lit `k, C,y
Tank to Distribution Box y r./ �k‘
Distribution Box to Field/ Pit kkl Y v C `i'
Opening Sealed: .✓f - N
End Cap t N
Inlet/Outlet Pipes &Baffles _,.Y N-
Manholes 12"or less below grade a-Y 7N
[provide extension collar if Yes] ^i,'Y_ N
Location/ Separations _
Foundation to tank \V ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plo a \ii/ N
Engineer Report an s-B ilt Y N
ETU Maintenanc ct _Y_ N
provided
Location of System on Property:
Front •-./ eft Sid: 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
L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Forms\Septic Inspection Report 03 29 10.doc
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I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS,TREES, FENCES, ETC
SHOWN ON THIS DOCU NT.I HAVE PERSONALLY
TOWN OF QUE ' ^B R T MEA E T E TFORTH ONT ISDIAGRA .
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BUILDING & *D, ` /I/ — SIGNATURE DATE
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