2013-167 TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
41111.
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130167 Date Issued: Thursday, May 02, 2013
This is to certify that work requested to be done as shown by Permit Number P20130167
has been completed.
Tax Map Number: 523400-289-008-0001-005-000-0000
Location: 42 NOTTINGHAM Dr
Owner: JERRY E HUNT
Applicant: JERRY E HUNT
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 ('- (cIP lOt
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*** TOWN OF QUEENSBURY
..4 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130167 Application Number: A20130167
Tax Map No: 523400-289-008-0001-005-000-0000
Permission is hereby granted to: JERRY E HUNT
For property located at: 42 NOTTINGHAM Dr
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: JERRY E HUNT Septic Alteration Residential
42 NOTTINGHAM Dr Total Value
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans&Specifications
2013-167
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, May 01,2014
(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 of Que bury
/We es A 4 ay 01,2013
SIGNED BY - \ for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12824J� 2013
Office Use Only NF1
qq
TAX MAP NO. of g q . 1?'1""5 PERMIT NO. /3 — / to PERMIT FEE </6/
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW4E. ISSUANCE OF A VALID PERMIT.
7-err OWNER: t l n+ INSTALLER: . . 1 S nrVi C
ADDRESS: T) Kt^O 1 n5 Dr ADDRESS:1 IO\iv'?cWO,rr i'(--,(\A "
PHONE NOS. '))_ \' c t+ PHONE
PHONE NOS. —19R11 1
;
LOCATION OF INSTALLATION: -TT I .
V`D" 11 CIS 11,• .
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older N X 150 = IV INSTALLED?
1981-1991 X 130 = d SPA OR HOT TUB
1992-present I\1 X 110 = INSTALLED?
PARCEL INFORMATION: \f
✓ TOPOGRAPHY: FLAT RO ING J STEEP SLOPE` %SLOPE\\I \�
✓ SOIL NATURE: SAND t� (LOAM I" 1I CLAY 1h�� OTHER\j \\
✓ GROUNDWATER: AT WHAT DEPTH? 1V t4
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? 1� nn
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is:\ t) ft)
✓ PERCOLATION TEST: RATE IS iv !1 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: )CC) 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.C,.F.1)-11'a
SYSTEM T PE: L n\
ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench LfX '1
o SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? N1 Size? \U '\
❑ALTERNATIVE SYSTEM Bed or other type? � ]"1
o HOLDING TANK SYSTEM Total required capacity? _Tank size ? J 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 the , .nd all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanita •*'- Disposal Ordinance. codesftueensburv.net
re of •erson Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
Sign
www.aueensburv.net
c 1 h ti rs to-IA
Cion
Septic Inspection Report
Office No. (518) 761-8256 Date Ins.- ion r-■ ,est ••cei ed:
Queensbury Building &Code Enforcement Arrive: Y- gr'�;., • •epart: 0.'-
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial • �,A
NAME: ._ , #14i ' 'MIT NO.: / a`/1(2
LOCATION: •y , 1%J 4 hat vv', SPECT ON: S-A-/ 2
RECHECK: J
Comments and/or diagram
Soil T .,;,s •. or •.m .
Type of Water: Municipa ell Water_2r-
Waterline separation nce ft.
Well separation distance L 00 ft.
Other wells: 1 CO ft. -t-
Well
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length __ ______LM____ft.
Length of each trench ih ft.
Depth of trenches t - - ft. �., . `� `�i ;
Size of Stone 4- ' : .4‘".4. mfir
Seepage Pits: Number F'
Size: x
Stone Size:
Piping Size Type
Building to tank E,c c4;T )ti(=,
Tank to Distribution Box 4 '` PO(
Distribution Box to Field/ Pit t-( `` gvC_ -Co L1 '' 'c' . -
Opening Sealed: N
End Cap _\--"Y N
Inlet/Outlet Pipes& Baffles N
Manholes 12"or less below grade _Y ...--e
[provide extension collar if Yes] � N
Location / Separations
Foundation to tank 1 ft.
Foundation to absorption __ eft.
Separation of Pits -��
Conforms as per Plo ' . _✓Y N
Engineer Report a : As-Built . - _ N
ETU Maintenan e Coo . _Y_ N
provided
Location of System on Property:
Front Rea' Side a•' •.- Middle Front Middle Rear
S stem Use Stat .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS 5 OCUMENT.I HAVE PERSONALLY
0 MEAS // itNCE SET FORTH ON TdiS DIAGIRAM.
/ ,es SIf-E7 DATE
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