2001-191 lek TOW OF QUEENSBURY
742 Ba Road ueensb NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010191 Date Issued: Wednesday, May 02, 2001
This is to certify that work requested to be done as shown by Permit Number P20010191
has been completed.
Tax Map Number: 523400-302-018-0002-069-000-0000
Location: 18 HUGHES Ct
Owner: RICHARD &MARY GARRETT JR
Applicant: RICHARD &MARY GARRETT JR
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
( JiØ
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Director of Building&Code Enforcement
TOWN OF QUEENSBURY
vero 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010191 Application Number: A20010191
Tax Map No: 523400-114-000-0009-010-000-0000
Permission is hereby granted to: RICHARD &MARY GARRETT JR
For property located at: 18 HUGHES Ct
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 &MARY GARRETT JR Septic Alteration Residential
18 HUGHES Ct Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
SIGNORELLI & SON
589 WEST MOUNTAIN ROAD
OUEENSBURY,NY
Plans &Specifications
2001-191
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,April 25,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the T exti uee bu ; esd ,April 25,2001
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Location of installation: 1 g 1-1-u9he5 Col..t r4- , QSb) Office Use
File Permit No. ) ) f I
Tax Map No. 0„5" �
Owner's Name: kr. ti 1-4(5• ,ward Fee Paid
1 j
Address: I$ 1-t1 in eS Co Le f- Q u ee h s loc y
2. INSTALLER'S NAME': long S 19no ce h PHONE NO. 7 9 2 - oa
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 3 x 150 gal/bdrm = F
1980- 1991 x 130gal/bdrm = CE�
1991 -present x 110 gal/bdrm = APR 2 4 2001
•
Garbage Grinder Installed yes o TOWN OF QUEENSBURY
Spa or Whirlpool Installed yes /,•!
BUILDING AND CODE
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
T aphy So' .._.- ure Ground Water Bedrock or Impervious Material Domestic Water Supply
Fla sand at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay 7_ if well; water supply
_%slope other from any septic-system
depth: 20 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 gallon (min. size 1,000 gal:)
Tile Field: each trench 52' ft. Total System Length: 9-e(-0 ft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: J,v/ 4/o 4 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
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible per on Date
,7, /8----
GENERAL INSPECTION REPORT
(518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement •
742 Bay Road
Queensbury,NY 12804. Arrive .-i/o am/pm Depart am/pm
1G Inspector's_Initials /4
0/-1?,/
NAME 'sick i U,�i G - PERMIT# {V/"fi 41/... (/�
LOCATION: °/® V . %l ( Al DATE : _- '
TYPE OF STRUCTURE:..::
RECHECK r I' ^k`' r; _M�
_.:. L-,-,' T6,!:,,,":- b cj I/ 4
,i L'
N/A YES NO COMMENTS
Footings/Piers l',, I I t`
Monolithic Pour Form'..
Reinforcement in Place \ _ //A'
The contractor is responsible for �"i
providing protection from freezing cif
for 48 hours following the placement ,;P
of the concrete. T \ / h
Materials for this purpose on site ' _
Foundation/Wallpour
Reinforcement in Place �i
Foundation/Dampproofing ,-,.
Backfill Approval ''
l }/
Plumbing Under Slab
Plumbing Vent/Vents in Place v / / /
Rough Plumbing 1 \, t(5- `7 L/A es.
Heating Rough-In i
Insulation / \ L/7 ' /' ,
Foundation Walls Interior R- / el2
Foundation Walls Exterior R- t?7
Floors R-
Walls R- rig
\ ,
Ceiling R-
Duct work or piping in
unheated spaces R- I
Proper Vent,Attic Vent
Framing /
Jack Studs/Headers /
Bracing/Bridging ,/
Joist Hangers /
Jack Posts/Main Beam! . \\\\
Air Infiltration Barrier
Fire Separation 1,2, 3,hour •
Penetration Sealed
Fire Wall 2,3,4 ho '�,,
Firestopping
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 J�
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location a'Lvc,(g---4-, C;, •
Date 5(7_, 01 Permit # b 191
SOIL TYPE: Sane •am-Clay-
Results of Perc'lat'on Test-
(if applicable) Rate Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tot.1 Lengtf� -5
Length of each tre ch -}�
Depth of trenches
Size of stone
SEEPAGE PITS: Numbe -
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Y-. o Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPERTY
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
C� &C'u ci3 -cvP
SYSTEM USE APPROVED: YE NO
Arrived: 47 , //�
Departed: "�
Building Inspector
. , 0' V
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road ??,�w-
Queensbury NY 12804 l/
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION (/J
Name (mP , r z:_-.
gi. C17
Local one
Date 1 -A Permit # 6Y 1J
SOIL T . Sand- oa Clay-
Results rf -Re rcolatio Test-
(if appli ,able) Rate- mute/Inc h
TYPE OF S ITEM:
ABSORPTION IELD: Total Length
Length of e. h trench ! 60
Depth of tre• h s 2J
Size of stone 4)F/L7fL diF )
SEEPAGE PITS: umber-
Size - t. x ft.
Stone size .
PIPING: Size Type
Bldg. to Tank - °` '
Tank to Dist. Box , . " -5.z 0
Dist. Box to Field/"- t, 0
Openings Sealed? ( e's No Partial
LOCATION/SEPARATIO' .
Foundation to Tank
6/�✓/feet •
Foundation to Absorption __ Q.feet . .
Separation or Pits feet
Conforms as per Plot P an es No
LOCATION OF SYSTEM ON 'ROPERT .
(circle one)
ron - Rear - Left Side - Right Side
Mi.. e Front. - Middle Rear
COMMENTS: / 47 .
- 6p 4 2,/} - c_, c )0(:1 -
O/L Ca iic-e
SYSTEM.USE APPROVED: • YES NO
Arrived:
Departed: '
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Building Inspector
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''ID —', 9/ I. .
"I have seen or-observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc., w
• J shown on this document. I also represent that I have - - c . M .
'personally measured the distances set forth on the diagram." D 0
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SIG TURF DATE z jR N . t.
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