2014-334 TOWN OF QUEENSBURY
isS 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140334 Date Issued: Thursday, July 31, 2014
This is to certify that work requested to be done as shown by Permit Number P20140334
has been completed.
Location: 42 NACY Rd
Tax Map Number: 523400-289-006-0001-029-000-0000
Owner: THOMAS & VIRGINIA ETU
Applicant: THOMAS & VIRGINIA ETU
This structure may be occupied as a:
Septic Alteration Residential By Order of Town Board
TOWNnOF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property GGGwwwaa���f/ I
owner of the responsibility for compliance with Site Plan,Variance, or
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
` I 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140334 Application Number: A20140334
Tax Map No: 523400-289-006-0001-029-000-0000
Permission is hereby granted to: THOMAS &VIRGINIA ETU
For property located at: 42 NACY 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 &VIRGINIA ETU
42 NACY Rd Septic Alteration Residential
LAKE GEORGE, NY 12845 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
MORNING STAR SEPTIC
793-2290 744-8139
107 JEWELL Rd
GANSEVOORT NY 12831-0000
Plans&Specifications
2014-334
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 28,2015
(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 Tow of Qu sb i �; -i - -y 28,2014
r '
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
"
n'_ n`
'".l SEPTIC DISPOSmL PERMIT INr c t 1 orica1US2 Only
r9S- 4,44-��'Ree ivied `
DATE d` ' 111E25201�TaxMpl{D � B9 -% -i-a9
TAXMArID ��� PuRit•No. /y�33ei
pF (1t)EE:. pergiit Fee
LOCATION OF INSTALLATION \ TOd�iLOING f< r 'Approvals:
APPLICANT -e'..5 57;,_ PHONE/E-MAIL
ADDRESS (f
INSTALLER/BUILDER: .a-� 5-ren- S r PHONE/E-MAIL 7,3 2 2- t s
ADDRESS: - /o 7 ((Jc9ew� 2Q. //`-n
OWNER �.wq�..�l/ �/r-• PHONE/E-MAIL 7Q 2 Tel 2 L
Address v /
/ , . t . Qa
y, - Al„,� . /
CONTACT PERSON'FOR BUILDING,&CODES COMPLIANCE: fr'A'-A SNAti PHONE ')r�r{'Ill
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed _Y _N
1981-1991 /fl 4/5-c.? Spa or Hot Tub installed _Y _N
1992-Present
PARCEL INFORMATION
Topography <CFlatrolling Steep slope %slope /�
D`-
Soil Nature _Sand Loam _Clay Other „_ _ Iv
Groundwater At what.depth? / - �"�""
Bedrock/Impervious Material At what depth?
Domestic Water Supply _Municipal C Well(if well,water supply from any septic system absorptioh is ft.)
Percolatioh Test Rate: ,per minute per inch(test to be completed by licensed engineering I architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size /rte gallons-(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinderor spa or hot-tub)
System Type g Absorption field with 42-stone Total length ft.;Each trench x.
Seepage Pit With#3 stone How many: r2 •size r?:* to`
Alternative System Bed or other typo?
Holding Tank System Total required capacity? Tank size #of tanks _
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We willno longer
allow systems to be covered until such lime as an As-Built plan is received&approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure-to make a material.fact or circumstance know by or on behalf of an applicant,shall be void. I have read the reguiations and
agree to abide by these arid all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: FrA.uA,acw Date: n_ p. 2S---/ y
Signature: 1Z Date: !/��X
6
Town of Queensbury Building&Codes Principal Structure Application July 2014
Town of Queensbury Building & Code Enforcement tchsj /o—/..?
i Office No. (518) 761-8256 ( to —Il')
Septic Inspection Report
Inspection request received:
Name: 1.4-' ti Inspected on: 9-30 —
`1
Location: "` d icQtc Arrive:
Permit No.: l<4-3 3q Inspector's Initials: n'
�
Co n is and/or dia•ram
Soil TypeCSand)LQam/Clay
Type of Water Municipal/Well Water
Waterline separation distance ft.
Well separation distance 150 ft. Tb P—Sex.
Other wells. (\\O ft.+ To 0—Bot
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 7--
Size:
Size: B x to
1 Stone Size: A---.-
Piping
Piping Size Type
Building to tank ,_44brxt ED
Tank to Dist utrofgam ibtki-`attow) it
Poirezpistribution Box to Field/Pit " LAA yp 4" Or 5 'Co \7.%• -•
Opening Sealed: N
End Cap —Y—N s Li
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 0145f ft. Y -? o%ccn 04S t% .
Foundation to absorption Wil ft.
Separation of Pits
Conforms as per Plots-B _fY—N
Engineer Report an(t`As-B� N
ETU Maintenance Contract provided Y N
Location of S stem to .o.e •
Front Re'eft Sid• 'fight Side Middle Front Middle Rear
System Use Stat .:
- Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
� .
518-793-2290
Fax#518-793-2115
E-mail: momingstarseptic@hotmail.com
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www.momingstarseptic.com
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Date: '"t 107 Jewel Road,Gansevoort, NY 12831
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Reviewed By:
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SEPTIU PLO I a___
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS,TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT I HAVE PERSONALLY
MEASUREDT" rTNI�,CESET�iJ/THONTHIS DIAGRAM.
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RX Date/Time 0712812014 13:53 5187932115 P.002
07/28/2014 13:31 5187932115 MORNING STAR SEPTIC PAGE 02/02
.. �- 5187983659 T0:7932115 P.2 2
'Jiie28-2014 13:15 FROM:G. PETER JENSEN
G.Peter Jensen
17 West Road
South Glens Falls
New York 12803
(518)798—3859
July 28,2014
To Whom It May Convent
Today,July 28,2014,I conducted a soil percolation test at the Thomas Etu
residence,42 Nacy Road,Lake George,Town of Queensbury,NY.The testing resulted in
a stabilized percolation rata of 4 minutes and 01 second.
Sincetel
G.Pete jr-, -:, •- et.Aqe
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