2010-126 TOWN OFQ UEENSBURY
Foos
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Qu ury,
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100126 Date Issued: Monday, June 07, 2010
This is to certify that work requested to be done as shown by Permit Number P20100126
has been completed.
Tax Map Number: 523400-301-012-0003-013-000-0000
Location: 7 HILLCREST Ave
Owner. SCOTT & ADRIENNE CROSS
Applicant: SCOTT & ADRIENNE CROSS
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, lim + '
Variance, or other issues and conditions as a result of approvals by the
Director of Building&Code 'nfox+ce ent
Planning Board or Zoning Board of Appeals.
111h TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100126 Application Number. A20100126
Tax Map No: 523400-301-012-0003-013-000-0000
Permission is hereby granted to: SCOTT&ADRIENNE CROSS
For property located at: 7 HILLCREST 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: SCOTT&ADRIENNE CROSS
7 HILLCREST Ave Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-126
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, April 08,2011
(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 own Que buil; T -- . .y,April 08,2010
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
1�,/ / 3-/ ---s- OFFICE USE ONLYil. '."0: , 'MAP ,:= �I,'.. �,NO. PERMIT NO. �' PERMIT F ;; I y'.. = + !1
FEE
. ` , ; Iii
TAX APPROVALS: ZONING TOWN CLERK �' _ �w�ti h ��)�� 1
APP � 21
-h ' _•
z:1l: .-
LICATION FOR SEPTIC DISPOSAL SYSTE �_ it_ �, .:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEF 1
PERMIT.
_i �� ` ORE ISSUANCE OF A VALID
OWNER: D C/ C�-PS> ...�
l<
/ INSTALLER: /e, .---, CAWecK('
ADDRESS: /l/ l',dc'`si e 0 _
ADDRESS: /Y„,,/,v„,,,,
PHONE NOS. s r?7 790Z--/�
PHONE NOS.
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF X COMPUTATION=
BEDROOMS RESIDENCE INFORMATION:
1980 or older = TOTAL DAILY FLOW
X 150 gallon per bedroom _ GARBAGE GRINDER
1981 -1891 Vic) INSTALLED? N C
X 130 gallon per bedroom
1992-present X 110 gallon per bedroom = SPA HOT TUB
INSTALLED?�_
PARCEL INFORMATION: /
✓ TOPOGRAPHY: Flat rolling 1J
-�_ Steep slope %Slope_
✓ SOIL NATURE: Sand
Loam Clay Other
✓ GROUNDWATER: At what depth? _
✓ BEDROCK/IMPERVIOUS MATERIAL: 't what depth?
✓ DOMESTIC WATER SUPLY• MunicipaWell
(If well: Water supply from any septic
I PERCOLATION TEST: Rate is system absorption is----.__ft)
fper minute per inch.
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systerns must be designed by
a licensed professional engineer or architect(unless installed in a Planning Board approve
TANK SIZE: /4''' --cpP d subdivision).
GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
E 51;�i. each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each
0 SEEPAGE PIT(S) (WITH N0. 3 STONE How trench X
many? Size?
, ALTERNATIVE SYSTEM Bed or other ? t��e/r
type• � ,PfF-irQ S _ 5-e) l
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
`` NOTE: ..:::...: ..:.:.:.....:...:.:.:.:.::.:.:.:.:...:.:..:.:.:.:.....:.:.:.:.:...:.:...:.:...:.:...:...:.:.....:.:.:.:...:.:.:.....:::..:
ALARM SYSTEM AND ASSOCIATED ELECTRICAL W
APPROVED ELECTRICAL INSPECTION AGEN ORK MUST BE INSPECTED BY A TOWN
CY. PLEASE REVIEW LIST PROVIDED. I.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of ni i.„,, ..k:.-.. -'
permit or approval granted which is baRnri ::►,,,,,
(" — /0 (-4,e, --..4-7_.
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ m Depa •• am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
`�
cNAME: PERMIT NO.: // ---j --LOCATION: r.76� Al‹._ INSPECT ON: L!' _
-AD
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
6
Well separation distance ft. t ,
Other wells: ft. -7Ca-'k. (.QS1"
Well Casing Length ' 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total lengthjr� /N `'" 2.5
Length of each trench •
Depth of trenchesIMI F LCA/"° ttile r9X
Size of Stone _ �
Seepage Pits: Number \/ ,� -
Size: x
Stone Size:
Piping Size Type V!�`�)i TD V _. (
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit %1'1:- V IA, 'Fir?e
1
Opening Sealed: Y N
End Cap Y N CKt- c-A-M
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. q _ r
Foundation to absorption ft. '`,�-= `'CG,= `—`
Separation of Pits ft.
Conforms as per Plot Plan ____ Y_N
Engineer Report and As-Built Y T N
ETU Maintenance Contract _Y N
provided
Location of Syn Property:
Front R Left Side Right Side Middle Front Middle Rear
stem Use S
Approved -
Partial Approved and needs t 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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such .-) houses, wells, trees,fences, etc.,
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QUEENSBURY
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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: /
NAME: Cr055 PERMIT N .: ,M 1Z �v
LOCATION: .? /1; 73+ INSPECT ON: 4--2%it-)
RECHECK:
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 Cas' g ngth 50'+/ - Y N N/A
[1501/to w II required if NO]
i
Absorb Fi Id: Total length ft.
Leng of each trench ft.
pth of trenches ft.
Size of 5tone
Seepag= Pits: Number V �� �- \�`
Size: x �� T
Stone Size: '
•'•ing Size Type k± A4,-.4-17-NA,
Building •'tank
Tank to Distribute' Box
Distribution Box to Fi-Id Pit
Opening Seal...: Y N
End • •. Y_N f 1!'S1s<'� . f---1) -)'i\-A,---
Inlet/Outlet
1) -�' �,
Inlet/Outlet Pi &Baffle Y N ��`v
Manholes 12"or less low grade _Y N 0,N --('',
r� z ,t[provide extensi collar if Yes] Y Nt-.'t�"' "'
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built —N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
system Use Statu- '`-�--_,\
iAp•raved
,i/ Partial Approved and needs be re-inspected, please call the Building &Codes Office
ID.543•proved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report03 29 10.doc
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: : 1 cam/pm
0
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: c
7%
NAME: / fl( PERMIT NO.: /0 --- j 6 .
LOCATION: - nj d/(e_)T1 - I1j INSPECT ON: - -- D
RECHECK:
Comments and/or diagram
Soil Type: .:,,r' k.am/ Clay
Type of Water. ,. Well Water ,
Wate r paration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A Fz2-1-L,_ Fvc��Absorption Field: Total length "Z . 'c5 ft. — " I
Length of each trenchft.
Depth of trenches ANY 70----
2 1,1•3F-O.
Size
,1•3F-
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank ki-2. (31.2..,1
Tank to Distribution Boxpc.
Distribution Box to Field / Pit
Opening Sealed: _Y
End Cap _Y N
Inlet/Outlet Pipes&Baffles _Y_ N
Location/ Separations
,.,, ,�p
Foundation to tank k ' ft. 14i-l -)--\1 ?_71'.. $ �-
Foundatlon to absorption i ft
Separation of Pits
Conforms as per Plot Plan _Y N 'F ft '� c:-L17 -1,61---t.,_ r_t_c_to ----r-er
Engineer Report and As-Built _Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Stat s:
Partial Approv-a' d needs to be re-inspected, please call the Building &Codes Office
o -.
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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such t''1.), houses,wells, trees,fences, etc.,
. .-..,- thisurr3rt. I also represent that I have ,
doasui-ed H-le icfances set f" th on the diagram."
TOVOF QUEENSBUPY
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Revie ed By: , •
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COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
-,I I 1 10160 -in Card No.....................................
Permit No........ r:..... ..
./_.'........Cert' N 0- Cut
Owner............ .........(. e ......
Location.7... ..............................................6, ...............
Installation Consisting of .........................
....................................... . ................................I...................................
....... ....
..........................................................................................................................................................................
; '1'6 A;t`
InstalledBy...:.....................................................................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of makx'rg—i'4spections at any time, and if its
rules are violated,the Company shall have the right to ro. e this Jcp I dific'3k;F.
Date.... .................. INSPECTOR...... .... .......................................................................
Member N.F.P.A.,I.A.E.I.