2005-319 TOWN OF QUEENSBURY
742 Bav Road,Queensburv,NY 12804-5902 (518) 761-8201
(zt Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050319 Date Issued: Tuesday, May 17, 2005
This is to certify that work requested to be done as shown by Permit Number P20050319
has been completed.
Tax Map Number: 523400-288-016-0001-043-000-0000
Location: 31 MC CORMACK Dr
Owner: RICHARD & LUCILLE NICHOLAS
Applicant: RICHARD & LUCILLE NICHOLAS
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 )jW
property owner of the responsibility for compliance with Site Plan, 4f
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: P20050319 Application Number: A20050319
Tax Map No: 523400-288-016-0001-043-000-0000
Permission is hereby granted to: RTCHARD & T,IICII,T,F,NTCHOI,AS
For property located at: 31 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 & LUCILLE NICHOLAS
31 MC CORMACK Dr Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name / Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2005-319
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, May 24, 2006
(If a longer period is required,an application for an extension must he made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the own Que b ; Ae
, May 24, 2005
4
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
- Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: .....................................................................................
Office Use
Location of installation:-3 1 1L CD(Z M 4d4- b(zl�16 2
File Permit No. ::nos !3 1
Tax Map No.
Fee Paid - CTO
Owner's Name: V.04 AL) V 3L n.,L
Address: -3 /"T t_ t7�NCI Jl-( k i ci c
2. INSTALLER'S NAME 4L, PHONE NO. 7 q,� -7,2 57?
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply #of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm = 0 a
1980- 1991 x 130 gal/bdrm =
1991 -present x 110 gal/bdrm =
Garbage Grinder Installed yes— / no
Spa or Hot Tub Installed yes / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
TowaaDhv Se+Nature Ground Water Bedrock or Impervious Material . DoMjjkiLWater Supply
Fla sand at what depth at what depth uni
o ing feet feet w
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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:I Ogg - gallon (min. size 1,000 gal)
Tile Field: each trench �7 '�' ft. Total System Length:o?o C---) ft. RECEIVED
Seepage Pit(s): number of size of each: / ft. by ft. Maur € (1 '
Size of Stone to be used: # 0 I depth or thickness feet TOWN OF QUEEWSBURY
$UILDING AtilLCODE
Bed System Size: x V
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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
require e Town of Qu b Sanita Sewage Disposal Ordinance.
Si nature of respo i le person bate
�lo'.Vtt of ��ltt;(�tt;4l}tiny
sr,wers :ttul Sewsine Disposal (:l,sls}i(•r
!tI}pmulix C.
• r
&Utit)R1''• ION IP I P111A.)
SI:I'AItN11ON RENJ1, IRIP11UN'I'S
Z-5
POND
c,+ay .
7. SKWATURE &INFORI LkTION FO.Ft.:Mr(jNbWLr.rz"v;. M..a,sa.o 4 .w ,
}
Septic Inspection Report
Office No. (518)761-8256 Date Inspection re st cei ed-
Queensbury Building&Code Enforcement Arrive: m/pm art: a
742 Bay Rd., Queensbury,NY 1280(4� Inspector's Initia
NAME: ! 4 �` P IT NO.: �Q lJ J/
LOCATION: ; A PECT ON: _
RECHECK:
-- Comments and/or diagram
Soil Typ<SanClay
Type of Water Munici al` Well Water
Waterline separation istance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench p ft.
Depth of trenches 7, ft.
Size of Stone
2—
Seepage Pits: Number
Size: x
Stone Size:
-Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to-Field/Pit
OpeningSeale /Partial
End Cap*
Location/Separations
Foundation to tank ft.
Foundation to absorption F7 I 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 Fro ddle Rear
System Use Sta s•
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
a Y
319
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RECEIVE® � -
MAY I A 2005 0
TOWN OF QUEENSBURY
BUILDING AND CODE
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