2007-763 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4E Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20070763 Date Issued: Monday, December 31, 2007
This is to certify that work requested to be done as shown by Permit Number P20070763
has been completed.
Tax Map Number. 523400-289-008-0001-003-000-0000
Location: 56 NOTTINGHAM Dr
Owner. DANIEL ELLSWORTH
Applicant: DANIEL ELLSWORTH
This structure maybe 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,
Variance, or other issues and conditions as a result of approvals by the Dire o ding ement
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: P20070763 Application Number. A20070763
Tax Map No: 523400-289-008-0001-003-000-0000
Permission is hereby granted to: DANIEL ELLSWORTH
For property located at: 56 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: DANIEL ELLSWORTH Septic Alteration Residential
374 STATE ROUTE 149 Total value
LAKE GEORGE, NY 12845-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2007-763
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,December 31,2008
(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 Queensb ry; Nionday, December 31, 2007
SIGNED BY for the Town of Queensbury.
/4�
Director of Building Code orcement
•................►...Poo.......►►.....►....►....►...................... r..rrr......►.........�
OFFICE USE ONLY - 1 ; +
TAX MAP NO. �� PERMIT NO. ERMIT 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:-614-n 151019 f)q4 _ INSTALLER:
ADDRESS: 57f y L� ADDRESS: A Lal `L
PHONE NOS. PHONE NOS.�f a 6��
LOCATION OF INSTALLATION: �G' 'eo"AM fi ,ty �!r��
-.. ... _.......................... x .. .................-.._..........-..•........... ..».....•.................................. ..•,.: ...•..••.....-.••.....•......... RESIDENCE INFORMATION:
YEAR BUILT NC.OF X COMPUTATIONs : TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINO�j�
-µ1980 or older ---»-- C/ µ--µ X ,150 gallon per bedroom . : ,-.- -. µ .- .. INSTALLED? .�
-1981 -1991 X 130 gallon per bedroom s _ _ SPA OR HOT TUQ:)
-1992-present»x .
. ..... --..N ...X »-1.10 gallon per bedroom... ..'...............». »•.-......-...�N��-._......._� INSTALLED?
PARCEL INFORMATION:
✓ .TOPOGRAPHY: FLAT ROLLING / TEEP SLOPE %SLOPE
✓ OIL NATURE:SAND LOAM CLAY OTHER
✓ QRQUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DQME TIC WATER SUPLY: MUNICIPAL—_-_,._ WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS/AQ w)
✓ 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.,
✓ SEPTIC TANK: GALLON (MIN.SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM L Nt NGTH: 2iL 5 FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH 2 FT.X FT.
✓ SIZE OF STONE TO BE USED:# '2 l DEPTH OR THICKNESS 1 FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH ANDIOR SIZE
✓ HOLDING TANK SYSTEM:(if required) NO.OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
J JW,xN NW4•xWWW.xxI•xIWNNI.J.NJ.J•NN.•,........J4.x1•YNxJ•IN•1•NJ......"4.NxJN•W4.14.J•NJ4.1,—",",NNW'NNNNNNN......44V•NJ•✓VJ.J..4•...4N•.4.NJ......•J.1...N..1......•J....•...•J4N•.•NNJ4.J.1.1•.N•NNNNx.y..•I.1.J.J.IN.1.1•••J•1•WyxYN14•NN.•.•JN4•...•NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
y!APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.I ! NJ.J4.N1944TI•xNUJ•U.Nq•NNNNNxNNNNW4N•.N4•
For your protection, DleaSe note that nurcuan+4^ •A� ^-
3_, 36
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request;received:
Queensbury Building&Code Enforcement Arrive: 9,3- am part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: PERMIT NO.: d
LOCATION: INSPECT ON: 1 ti ILI 3
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam Cla
-Typeof Water: Munid I/ ell Wa_tkr
Waterline separation distance
Well separation distance i- ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench S6 ft.
Depth of trenches 2" ft.
Size of Stone Seepage Pits: Number
Size: x
Stone Size:
Piping Size T
Building to tank nc
Tank to Distribution Box S
Distribution Box t eid Pit
Opening Sealed Y N Partial
End Cap J
Inlet/Outlet Pipes&Baffles Y N
Location Se rations
Foundation to tank ft.
Foundation to absorption ®r ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Fr9W 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
Last revised 021006
Last revised 1/6/05
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: - 11,'6� am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: JN�-
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft,
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
-Openigg Sealed: Y NJ Partial
End Ca
Inlet/Outlet Pipes&Baffles Y N
Location/Se rations
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
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use tus:
_Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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` { SURVEY
MAP REFERENCES _
1- MAP OF SHERWOOD ACRES. BY COULTER & MCCORMACK LLS, DATFD f OF LANDS OF
LEGEND: MARCH 31, 1971.
; .€E
• FOUND IRON MARKER z WARREN COUNTY. TOWN of QU£ENSBURY, TAX MAP Na 289.80, BLOCK IEL L. ELLSWORIH
1, PARCEL NO. 3, L 1141 P. 75� �+
O SET IRON ROD WI TH CAP
O POINT
--E POWERSTONE LINE TOWN OF OUEENSBURY, WARREN COUNTY, NEW PORK 0.r
��STONE WALL 6
-x_X-
FENCE SCALE: 1" = 30' DATE-- OCTOBER 17 2007
'
ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY
MARKED WITH AN ARIdNAL OF THE LAND SURVEYOR'S `
EMBOSSED SEAL OR INKED STAMP SHALL BE - • , { .
CONSIDERED TO BE VALID TRUE COPIES
Fo 0 vPJIM
Unauthorized Alteration to this mop is o Rwn(w A.S.=A� � o s Lkwlmd LapW Skwwywv •
violation of Section 7209, Subdivision 2 G to" Spvt'oga Roos( P.Q Bbx 1434 07-175
of the New York State Education Law. '
W1LUA,N J. ROUR UCEN LAND SURVEYOR NO. 49098 South Qlw* Taft IKY. 1280
JOB NO.