2011-443 iA TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110443 Date Issued: Friday, January 11, 2013
This is to certify that work requested to be done as shown by Permit Number P20110443
has been completed.
Tax Map Number: 523400-308-012-0002-057-000-0000
Location: 87 PINEWOOD Rd
Owner: RICHARD NORTON
Applicant: RICHARD NORTON
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 ne ent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
FOS
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110443 Application Number: A20110443
Tax Map No: 523400-308-012-0002-057-000-0000
Permission is hereby granted to: RICHARD NORTON
For property located at 87 PINEWOOD Rd
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 NORTON Septic Alteration Residential
87 PINEWOOD Rd Total Value
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-443
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, September 01,2012
(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 To f e€..LueensbJ r; Thursday, September 01,2011
SIGNED BY t f 1✓ ' .',l ff :-4�'°'�"! for the Town of Queensbury.
Director of Building&code forcement
a 1
r
r ICE USE ONLY '
1, - --s.11Y�
TAX MAP NO2' i PERMIT NO. -- •,..?3ERMIT FEE 440° 1 Z
APPROVALS: ZONING TOWN CLERK •
APPLICATION FOR SEPTIC DISPOSAL SYSTEM C : 11 E
A PERMIT MUST BE OBTAINED BEFORE WORK EGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE IUAN
PERMIT.
OWNER: R1(1717(/ /'"10 i , /
INSTALLER: Gd_5- ,c (�
ADDRESS: +, f / /`1. i1/ L'r ADDRESS: / 9Y ; tf !1f AXA)07
PHONE NOS. PHONE NOS. ) l - er 7 -.7:5
LOCATION OF INSTALLATION: L lL
J
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED?
1981 -1991 X 130 gallon per bedroom =
SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Z7V 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 minutes per inch [MPI]
(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).
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; ,�t. Each trench b X
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
E--ALTERNATIVE SYSTEM Bed or other type? 17/7"I %
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size?i' ee Number of tanks? t
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.
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection • • - •
Queensbury Building &Code Enforcement Arrive: ' Z -,�����/ 0-part: 17Z-cG am/
742 Bay Rd., Queensbury, NY 12804 ` Inspector's Initials: .i
NAME: R CLr tti N C� • IT NO.: / f J 7
LOCATION: g 7 P yr..t2 I -.ECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft. /Y
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 _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
Opening Sealed: _Y T N
End Cap Y_Nwag.
Inlet/Outlet Pipes&Baffles Y___..N r e "
Manholes 12"or less below grade _Y_N p`
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank _ ft.
Foundation to absorption
Separation of P1.. ft. t
Conforms as per P • Plan N Gt°� ''
Engineer Report a • As-Buil Y_N q3v
-__ ``\
ETU Maintena - - act Y_N Ij --
provided
Location of System on Property:
Front R Left Side Right Side Middle Front Middle Rear
S stem U Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
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Community Development.Office cri --1
vo` Town of Queensbury • 742 Bay Rd. 4
Queensbury, New York •12804 PLOT PLAN 2-5 •
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Show all existing and proposed structures. In
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Septic Inspection Report 01-jc dqRe /Win
Office No. (518) 761-8256 Date Inspection ed:
Queensbury Building&Code Enforcement Arrive: f- a ��/o . Z.- t I am ,
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ��I
NAME: 'Davi CDDic g' -D(/l oishr) •MIT NO.: ?c u- 4/83
LOCATION: VI PiN✓ tfr 1 G SPECT ON: (//.2./ _0//
RECHECK: gOt1
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.
Well Casing Length 50' +/- Y N N/A
[150'to well required if NO]
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
Opening Sealed: _Y—N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade Y_N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan T Y_N
Engineer Report and As-Built _Y_N � � Ar.... ........R)1.
ETU Maintenance Contract Y N te- / �
provided -�
Location of System on Property: V--
\ y�r '� Sc.j-1I4
Front Rear Left '•e Right Side Middle Front Middle R earr
st-m Use o -.
I
al Approved and needs to be re-inspected, please call the Building &Codes Office
alli Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Repor t_03 29 10.doc
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Septic Inspection Re. •rt
Office No. (518)761-8256 Date Inspection .if :• -i`•.:
Queensbury Building&Code Enforcement Arrive: = a v - . is+O, • , o m
742 Bay Rd., Queensbury, NY 12804 Inspector's In '• �?��'
NAME: .1( l^--, PETIT NO.: — iiii '...3
LOCATION: 'it�(,- / ' IN S. CT ON: : - - —
RECHECK:
r Comments and/or diagram
Soil Tye: m Clay _
Type of Water unlcipal ell Water
Wate ' ' distance 1-)v _ft.
Well separation distance ft. -8`� `� �
Other wells: ft.
Well Casing Length 50' +/- Y N N/A
[150'to well required If NO] --fir
Absorption Field: Total length 19' ft. y c0 V—- = 1 3'3+-5/0--= k ci 42
Le • hof each trench - 4 a i..A•
De. of trenches ft. �V
Size of Stone - -_F;9
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 9 tA C-
Tank to Distribution Box Li 12Lesc UFO
Distribution Box to Field/ Pit /Li c c-k Litt Vt l %L�-- t 1F--k\=
-�AZ--O-k ?
Opening Sealed: tJ'f N
End CapN.-
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade _ N
[provide extension collar if Yes] _N
Location/ Separations — -_
Foundation to tank \44 ft.
Foundation to absorption ) ft. ��
Separation of Pits
Conforms as per n Y 0 -E-.. Q - .; .- „--
Engineer Report d As-Buil Y
ETU Mainten
Y N C____C) �
Location of System on Property: tE\ E,
Front • -•• - i -'.- • •ht 111111
Middle Front Middle Rear
stem - ,t -
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Forms\Septic Inspection Report_03 2910.doc
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lift, Community Development Office Et 23 W
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va Town of Queensbury • 742 Bay Rd. E <
Queensbury, New York •12804 PLOT PLAN 0 z -%
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SIDE Ing SPE °L _. uses, wells, trees, fence->. �,i:u., v rn
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