2013-515 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130515 Date Issued: Friday, November 15, 2013
This is to certify that work requested to be done as shown by Permit Number P20130515
has been completed.
Tax Map Number: 523400-301-008-0002-024-000-0000
Location: 27 COTTAGE HILL Rd
Owner: NYSARC INC. WARREN & WASHINGTON COUNTIES
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 /I
property owner of the responsibility for compliance with Site Plan, ' /II—I .
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 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130515 Application Number: A20130515
Tax Map No: 523400-301-008-0002-024-000-0000
Permission is hereby granted to:
For property located at: 27 COTTAGE HILL 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: NYSARC INC. WARREN & WASHR
436 QUAKER Rd Septic Alteration Residential
QUEENSBURY, NY 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
2013-515
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, October 30,2014
(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
C ue� sbury0/We e i •s y y, October 30,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York -12804
Office Use OnlyQ T l0
TAX MAP NO. :D I' $ - D--a q PERMIT NO.f) 3 -.5 1, PERMIT FEE -4/ i l - fi
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.
Ar
OWNER: V`�a r(t' AkA S�v-N 5 W. INSTALLER: I S 5-e 6_, I (..
U U 1\pY ) ' ' Lle PN'�"'r'` ADDRESS: 1 We ( ✓1 if er �+ ' 1
ADDRESS: Q Q�I (}1� c( i 1
PHONE NOS. f) t =�O U PHONE NOS. � 3-43 J
5�
LOCATION OF INSTALLATION: 4I)T) CojAcl 5 t1.,
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRI q�R
1980 or older X 150 = INSTALLED? (T
1981 -1991 X — 130 = tv1� SPA OR HOT TUB
1992-present `\ x 110 = I�1 INSTALLED? WIf
PARCEL INFORMATION: III��V
✓ TOPOGRAPHY: FLAT R LLING V STEEP SLOPE\ Y %SLOPE I�1 I\
I SOIL NATURE: SAN LOAM I V N CLAY VII( OTHER\\11 k
1 GROUNDWATER: AT WHAT DEPTH? J\J
�
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WH T DEPTH? 1 vlI
I DOMESTIC WATER SUPLY: MUNICIP WELL\\ 1\(if well:water supply from any septic system absorption is: ft)
I PERCOLATION TEST: RATE IS \stir PER MIINUTE PER INCH[moil (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: 1)WLLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub. \p 0
SYSTEM TYPE: } � I
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length I' R ft. Each trench X lv1)..'
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? 1 Size? r I� 3-57411-3-57411- S eC'�r G NS
o ALTERNATIVE SYSTEM Bed or other type? IV I\ r
❑HOLDING TANK SYSTEM Total required capacity? _ N Tank size? \\J I\ Number of tanks?)\I /-).-
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 requir:ments of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
SanitaryS ge ' po • •inance. (� codes(a)queensburv.net
yL/�/y� ) VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of P n '/-,o sible a� t
9I. www.oueensburv.ne
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspectio -• -s •-ceiv••:
Queensbury Building &Code Enforcement Arrive: I ei•ft u
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: _
NAME: 6/.
(i 6. P',171 NO.: / 3 S °�
LOCATION: 1 e0 �' - �� SPECT ON:
RECHECK: 1
Comments and/or diagram
Soil Type:4-41,Loam / Clay
Type of Water: .. , , - .ter
Water -paration 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 1
Size: V x >•Z
Stone Size: -;•7
Piping Size Type AS B I11"
tnm6a
Buildin 9 to tank 4i*I hca-t K4
.ubTt }
Tank to Di&trr -Box 41\ t , '-
Pit /
Opening Sealed: ✓Y— N
End Cap _Y_ N
Inlet/Outlet Pipes&Baffles _ N
Manholes 12"or less below grade Y_N
[provide extension collar if Yes] Y N
Location/ Separations t-kco C p
61_9\(7) Foundation to tank
�Lp,C1, Foundation to absorption t '2r ft.
Separation of Pits tJ '
Conforms as per t Plan ✓N
Engineer Report nd As-Bui Y_ N
ETU Maintenance ontract _Y N
provided
Location of System on Property:
Front ear Left Side Right Side Middle Front fiddle Rea>
S stem Use S us:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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