2008-186 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
4z Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Pen-nit Number. P20080186 Date Issued: Monday, May 12, 2008
This is to certify that work requested to be done as shown by Permit Number P20080186
has been completed.
Tax Map Number. 523400-288-016-0001-054-000-0000
Location: 115 MC CORMACK Dr
Owner. RICHARD & BETTY MACAULAY
Applicant: RICHARD & BETTY MACAULAY
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
property owner of the responsibility for compliance with Site Plan, v
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: P20080186 Application Number. A20080186
Tax Map No: 523400-288-016-0001-054-000-0000
Permission is hereby granted to: RICHARD &BETTY MACAULAY
For property located at: 115 MC CORMACK 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: RICHARD &BETTY MACAULAY
115 MC CORMACK Dr Septic Alteration Residential
LAKE GEORGE,NY 12845 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2008-186
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, May 07,2009
(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 To of ens , May 07,2008
W SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONL---------------- ------
TAX MAP NO. PERMIT NO. � PERMir)
c r' I_� �1 n
APPROVALS: ZONING TOWN CLERK ; +
APPLICATION FOR SEPTIC DISPOSAL SYSTE
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT ORE4-4 �. ; ID
PERMIT. J�f /
OWNER: A,17//?o 1 t Pv INSTALLER: / Qti
ADDRESS: /I I '�- Cy /19/1 CAL 2 G ADDRESS:
PHONE NOS.1 J 3 —3 PHONE NOS. 7
LOCATION OF INSTALLATION:
................................................................................................................................... RESIDENCE INFORMATION.
NO.OF : I...........:...........................................................................
YEAR BUILT X I COMPUTATION= ! _ TOTAL DAILY FLOW
•......._._.................. BEDROOMS
_.............;. ........... ...........;.........................................................................`........... .................................................................. GARBAGE G IND EPWO
€ 1980 or older X 150 gallon per bedroom INSTALLED?
......................._........................................................................................................................................................_ ..... ...... ........w.....
s .. '•
1981 -1991 X 130 gallon per bedroom _ j
.....
................................................,......... .........................,...........;................................................................ ,, ...............,....................................... S U PA OR HOT TUB
;...........f.......... INSTALLED? fjo
1992 present X 110 gallon per bedroom
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT LLING STEEP SLOPE %SLOPE
SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT.-)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
F>"d'T..0 6
✓ SEPTIC TANK: ,OD_J GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH:.��fi:� FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS Z FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(if required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY.• GAL.
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 QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanit ewage Disposal Ordinance. codes®aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensbury,net
Ignature of Per on Responsible Date
Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury,NY 12804
Community Development Office
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S' Town of Queensbury • 742 Bay Rd.
Queensbury, New York •12804 PLOT PLAN
Show all exi Wosed� ructures. Indicate the setbacks of all structures and buildings from all property lines.
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Septic Inspection Report
Office No. (518) 761-8256 Date Ins request received:
Queensbury Building&Code Enforcement Arrive: 'L .1 am/ Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Ins is Initials:
NAME; PERMIT NO.:
LOCATION: INSPECT ON: =
RECHECK:
1
Commits_and/or diagram
Soil Type: SarnKdffi Clay
T of Wa unid I Well Water
Waterline separa6pnArstance ft.
Well separation distance ft.
Other wells: ft,
Absor tion Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Piping Si Type
Building to tank A11A
Tank to Distribution Box
Distribution Box to Field Pit �2 3
Opening Sealed: Y N Partial
End Ca
In Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank Mh ft.
Foundation to absorption imz ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle nt Middle Rear
s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05