2013-387 7" TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
_ �11
- _ Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130387-40210 Date Issued: Tuesday, March 21,2017
This is to certify that work requested to be done as shown by Permit Number P20130387-40210
has been completed.
Tax Map Number: 302.14-1-13
Location: 25 PERSHING RD
Owner: Thomas Hoy
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the 4
4/it
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
OaS 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20130387 Application Number. A20130387
Tax Map No: 523400-302-014-0001-013-000-0000
Permission is hereby granted to: THOMAS & SARAH HOY
For property located at 25 PERSHING 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: THOMAS & SARAH HOY
25 PERSHING Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Test Pit/Perc Test Review
Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
•
Plans&Specifications
2013-387
Res. SEPTIC ALTERATION
DEEP HOLE/PERC TEST completed 8/22/2013
$200.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, September 11,2014
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu before the iration date.),
Dated at the To of Q e b ; say, September 11,2013
SIGNED BY vvv for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 ,
Office Use Only /33 TAX MAP NO. 30 ) 4t'1 - I II 3 PERMIT NO. " 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 BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: -"QIf-\C Hc)-1 INSTALLER:111pi-:L
5 e pi-:
L� Pt('S�1�, 9\LJ`9 L_
' ADDRESS: IOVV--'?rV V or r.`..S
PHONE NOS. -106-3;1° PHONE NOS. 1 J 'J -yV 1 4
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINC1
1980 or older -. X 150 = LifQ INSTALLED? N
1981-1991 X 130 = SPA OR HOT TUptL
1992-present X 110 = INSTALLED? Iv
ry
PARCEL INFORMATION: /
/ TOPOGRAPHY: FLAT ROL NG STEEP SLOPEIV I\ %SLOPE V 1-\.
*1SOIL NATURE: SAND LOAM_ CLAY N !r . OTHER
✓ GROUNDWATER: AT WHAT DEPTH? lV
i
v. BEDROCK/IMPERVIOUS MATERIAL: AT W DEPTH?
1
li
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELLN`f)\ (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS 1 V rc 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 SIZE: 10 OC 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. e ,)--}i,/1
SYSTEM TYPE: p�
❑ABSORPTION FIELD(WITH NO. 2 STONE) Total length I' p 1 fL Each trench N X N.
O
EEPAGE PIT(S)(WITH NO.3 STONE) How many? t IV ` ` Size? W �'�
ALTERNATIVE SYSTEM Bed.or other type? 2Q b 1 1,A
o HOLDING TANK SYSTEM Total required capacity? _ {V r Tank size? I`.\ Number of tanks? IN
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 t - •r•• aquirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
SaPita•r - o�p�sal Ordinance. ,,� codesCa queensburv.net
Sign. _ •f 'erson/Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.oueensburv.net
Town of Queensbury Building & Code Enforcement CIVIC U.5
Office No. (518) 761-8256
Tam
Septic Inspection Report , z_ `�
Inspection request received:
Name: 0 Inspected on:
Location: a5��,(''Sh,V\ 6 Arrive: a.m.I p.m.
Permit No.: /3 3 V7 Inspector's Initials:
Comments andlor diagram
Soil Type: Sand 1 Loam 1 Clay
Type of Water: Municipal/Well Water
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]
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 Y_N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade Y N
[provide extension collar if Yes] Y N
Location I 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 provided Y N
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
Septic Inspection Report
411m
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
ikz Community Development-Building& Codes (518) 761-8256
Inspections per Permit
Permit# P20130387
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
08/19/2013 Miscellaneous Test Pit/Perc Test Review STAFF
Misc 2013-387
Perc Test app rec'd&entered
09/11/2013 Miscellaneous Test Pit/Perc Test Review STAFF
Misc 2013-387
permit issued
09/12/2013 Septic Test Pit/Perc Test Review JOHN O'BRIEN
Partial 2013-387
Need engineer's report
need as-built
01/09/2014 Miscellaneous Test Pit/Perc Test Review STAFF
Misc 2013-387
status slip issued
1' 1,LU Cd ct5 I-3 C om)
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection requc-' •.:
Queensbury Building &Code Enforcement Arrive: k - O a_,tcop '-part: Ir. .• pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials•` AP-
NAME: N
PO ,ERMIT NO.: / 3•'3 g9
LOCATION: fA1 t.n a INSPECT ON: Cj ic`.2-/'_3
RECHECK:
Comments and/or diagram
Soil Type: :.nd - 14. / Clay
Type of Water: . unicipa fr Nell Water
Wate '• - --•.ration distance R.Q1a jaigt.
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 (nO ft.
Length of each trench es ft. _\ _\ b
Depth of trenches \\I2- z ft.
Size of Stone
See Pj -N�ber
C Size: c 'x ZO
Stone Size:
Piping Size Type
Building to tank LA '' ik<- v:Ah..C\1'Jb
Tank to Distribution Box Li " )--)09.- 39
Distribution Box to Field/ Pit /LA`' h DQ— 3 h T v -s ' 5 5 ?COpening Sealed: _N
End Cap VY�//// N
Inlet/Outlet Pipes&Baffles ✓Y N
Manholes 12"or less below grade N I
[provide extension collar if Yes] _ Y N _ Es-c) 14t. �
Location/ Separations — a E0 0,6
Foundation to tank tib ft. Qv\'CV-
Foundation to absorption -2—. ft.
Separation of Pits ft.
Conforms as per Plot Plan Y
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 S
tatus:
zApproved
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
x
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury,NY 12804
Phone-518-745-4400 Fax -518-792-851
September 20, 2013
Project#49364
Dave Hatin
Code Enforcement Officer
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Re: Hoy—25 Pershing Road—Replacement Septic System
Dear Dave:
This letter is to inform you that we inspected the completed septic system for Tom Hoy located at
25 Pershing Road on September 13, 2013.
The replacement septic system as installed was for a three-bedroom house and consisted of the
existing 1,000 gallon septic tank and 20 ft wide by 20 ft long absorption bed with 4 — 15 ft long
absorption laterals constructed with stone and perforated pipe. The system conforms to the
requirements of the approved replacement system design drawings.
Please call me if you have any questions.
Sincerely,
Thomas R. Ce tdir Jr, P.E.
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