2011-309 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110309 Date Issued: Friday, June 24, 2011
This"is to certify that work requested to be done as shown by Permit Number P20110309
has been completed.
Tax Map Number: 523400-301-012-0002-02 1-000-0000
Location: 11 COLONIAL Ct
Owner: RICHARD SMITH
Applicant: RICHARD SMITH
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,
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: P20110309 Application Number: A20110309
Tax Map No: 523400-301-012-0002-021-000-0000
Permission is hereby granted to: RICHARD SMITH
For property located at: 11 COLONIAL 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 SMITH Septic Alteration Residential
DONNA DAVIDSON-SMITH Total Value
11 COLONIAL Ct
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications.
2011-309
septic alteration .
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 22,2012
(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 o ueen ry e es ay,June 22,2011
SIGNED BY r for the Town of Queensbury.
Director of Building&Code Enforcement
e ' d 4 010
OFFICE USE ONLY � �� P � r
TAX MAP NO. 1. �ERMIT NO. PERMIT FEE
qZfi
APPROVALS: ZONING TOWN CLERK
JUN 2 2 2011
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERi WITOWN OF QUE,�E,N�SBURY
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION SUI 1b@IV4�ERQW%EFOR
ISSUANCE On(F A VALID PERMIT.
OWNER: l�iG�cni f� SM 1 : 1^ INSTALLER: S I
ADDRESS: I Cn I Q�, i%n I � _-` ADDRESS: Qe��c��/�Q/(Uj,
PHONE NOS. PHONE NOS. J' t1 1 G 01 .I 1
LOCATION OF INSTALLATION: ;:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW ,
BEDROOMS Gallons per bedroom GARBAGE GRIN
1980 or older X 150 = O INSTALLED?
1981-1991 1 X 130 = IVA SPA OR HOT TU,�f t\
1992-present X 110 = INSTALLED? _
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOP %SLOPE_
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? �
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA —0
DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is:
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi]
(Test to be cdmpleted 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).
-�*
TANK SIZE: GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length �. ft. Each trench X 6 t� &Ail ed
I
❑SEEPAGE PIT(S)(WITH STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
[I HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
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.
have read the regulations with respect to this application and agree
to abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewa posal Or ' an I codes(&Queensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Signature erso sponsible bate www.gueensbury.net
Town of Queensbury* Community Development Office*742.Bay Road, Queensbury NY 12804
Septic Inspection Report
Office No. (518)761-8256 Date In cti n re ues a v . a-a-
Queensbury Building &Code Enforcement Arrive: ep am
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial
NAME: RMIT NO.:
LOCATION: 6^Lg L INSPECT ON: l+
RECHECK:
Comments and/or diagram
Soil Type
,• oam/Clay
Type of Water: Munici a ell Water
Water in a ration distance ft. `�r-- �p
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
150'to well required if NO
Absorption Field: Total length 7 ft.
Length of each trench ft. C
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank et
Tank to Distribution Box
Distribution Box to Field/ Pit LA
Opening Sealed: _ N
End Ca
Inlet/Outlet Pipes&Baffles _ N
Manholes 12"or less below grade _N/
[provide extension collar if Yes Y
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per PI Ian _N
Engineer Report an As-B ' _Y_N
ETU Maintenan e C ct Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side (:Middle Front Middl ear
System Use Sta :
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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