2010-195 a TOWN OFQ UEENSBURY
742 B NY 12804-5902 1 7 1-
ay Road,Queensbury, (5 8) 6 8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100195 Date Issued: Monday, May 10, 2010
This is to certify that work requested to be done as shown by Permit Number P20100195
has been completed.
Tax Map Number: 523400-301-007-0001-029-000-0000
Location: 10 BUENA VISTA Ave
Owner. HANNAH NASH
Applicant: HANNAH NASH
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, C:\DavP' 1
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code nfotte ent
Planning Board or Zoning Board of Appeals.
��` TOWN OF QUEENSBURY
FiFtN 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100195 Application Number: A20100195
Tax Map No: 523400-301-007-0001-029-000-0000
Permission is hereby granted to: HANNAH NASH
For property located at: 10 BUENA VISTA Ave
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: HANNAH NASH
10 BUENA VISTA Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2010-195
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, May 03, 2011
(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 wn o een rY' ►' da May 03, 2010
SIGNED BY �' for the Town of Queensbury.
Director of Building&Code Enforcement
For an EPA homeowner's guide: htto://www.epa.gov/npdes/oubs/homeowner guide long customize.odf
36A ) r 7 OFFICE USE ONLY
TAX MAP NO. PERMIT NO. 1_ H ERMIT FEE2 A ' 2010
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. , t
OWNER:- - _±4111t..L{ Iv I,1' INSTALLER: �i�il ��try 4 �
ADDRESS: - A-_( 1ST ADDRESS:
PHONE NOS. 93 - 2-7 3 7 PHONE NOS.
LOCATION OF INSTALLATION:
RESIDENCE
NO.OF
YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
1980 or older X 150 gallon per bedroom t = 6 d GARBAGE GRINDER,-
INSTALLED? N U
1981 -1991 X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA OR HOT TUB Kw
INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLI LG / STEEP SLOPE SLOPE_____ %
✓ SOIL NATURE: SAND ✓ LOAMCLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? _ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY:
MUNICIPAL& WELL t (If well:water supply from any septic system absorption is:( ft)
✓ 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).
TANK SIZE: 1 a-5 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:
o ABSORPTION FIELD (WITH NO. 2 STONE) Total length 9 /J_ft. Each trench !i 1 X
o SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
o 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.
I have read the regulations with respect to this application and agree QUESTIONS? CALL 761-8256 OR EMAIL
to abide by these and all requirements of the Town of Queensbury codesAqueensbury.net
Sanitary Sewage Disposal Ordinance.
VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
/.340
Ignature of Person Responsible ate
CITown of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
(2 ' oc) /-15 kkc/ekes
Septic Inspection Report
Office No. (518) 761-8256 Date Insion req - rec,- - . s
Queensbury Building &Code Enforcement Arrive: 1^_() a /p ' part: S; • - p
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials.
NAME: G(. 1P NO.: �
LOCATION: h '. G�
41-;(5)\
CL I 't'ECT ON: S —
RECHECK:
Comments and/or diagram
Soil T • oa /Clay
Type of Wa **Otte ell Water
W. paration 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 4 ft.
Length of each trench ft.
Depth of trenches ,- r tft.
Size of Stone -7
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 1,A,lkI/C.A-MO
Tank to Distribution Box y`t N
Distribution Box to Field/ Pit t` !�5?(� 3 t�
Opening Sealed:
End Cap VVV N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade ✓Y—N
[provide extension collar if Yes] _Y—N
Location/Separations
Foundation to tankft.
Foundation to absorption ft.
Separation of Pitsft.
Conforms as per Plo ' •n J _N
Engineer Report and • -Buil Y_ N
ETU Maintenance . act _Y_N
provided
Location of System on Property:
Front • •r Left Side Right Side Middle Front iddle R:..
stem U - • us:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Fortes\Inspection Fortes\Septic Inspection Report 03 29 10.doc
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T WN OF QUEENSBURY
ILDING DEPARTMENT
Based on dur limited examination,compliance
with our c ments shall not be construed as
C Pi yii-- indicating e plans and specifications are in
full compll nce with the Building Codes of
THIS PLAN TO BE 0 1-1 New York tate.
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PROJECT SITE AT
ALL TIMES FOR
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: ] } '`am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: t
NAME: )k PERMIT NO.:
LOCATION:r Al EWAMI ��1��� 14 INSPECT ON: AV=
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft.
W- -paration distance ft.
Other wells: ft.
Well Ca•ing L- gth 50' + / - Y N N/A
Absor•tion Fiel• Total Iengt ft.
Length o each trenc ft.
Depth of trench:s ft.
Si - of Sto e
Seepage Pits: Num•-r
S'•e: x
Sto ze: Bv-e_F\Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pi
Opening Seal-•. Y N
End -p Y_N
Inlet/Outlet Pipes&Ba -s _Y—N
Location/ Separat'•ns
• Foundation to •nk ft.
Foundation to abso,•tion ft.
Separation •f Pits
Conforms as per P it Plan _Y
Engineer Repo and -Built _Y^ N
Location of System on Property:
Front 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 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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