2010-176 .4-11111hi TOWN OFQ UEENSBURY
Fors
742 BayRoad,Queensbury,NY 12 4
��� 80 5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100176 Date Issued: Tuesday, April 27, 2010
This is to certify that work requested to be done as shown by Permit Number P20100176
has been completed.
Tax Map Number: 523400-295-014-0001-079-000-0000
Location: 5 HUMMINGBIRD Ln
Owner: EARL & CHARLOTTE TROOP
Applicant EARL & CHARLOTTE TROOP
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 thera-- (4P 41 \
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
`r 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100176 Application Number. A20100176
Tax Map No: 523400-295-014-0001-079-000-0000
Permission is hereby granted to: EARL& CHARLOTTE TROOP
For property located at: 5 HUMMINGBIRD Ln
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: EARL& CHARLOTTE TROOP
5 HUMMINGBIRD Ln Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: WAN BELL
2 LOWER WARREN St
QUEENSBURY, NY 12804
Plans &Specifications
2010-176
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, April 26, 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 o ee :17i o f da April 26, 2010
SIGNED BY ' for the Town of Queensbury.
Director of Building&Code Enforcement
�� :f OFFICE USE ONLY
.__. a;t=
TAX MAP NO. /— ?7 t °, :�
PERMIT NO. °�U` '� )
2 PERMIT FEE�.� � ;���
APPROVALS: ZONING ° ' °:''D
:-
TOWN - ' ' a ': ) )0
CLERK
APPLICATION
....................................��"-� ;.. _"_--_-_- .._
FOR SEPTIC DISPOSAL SYSTEM PERMIT
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW 1�Y1I1
PERMIT. BEFORE ISSUANCE OF A VALID
OWNER: _ Arr, v f
INSTALLER: l lie cc i e
ADDRESS: i
4_,A_ I T
ti ADDRESS: I• .1 ��
PHONE NOS. — ( _ r , ,,i CG CC
PHONE NOS. f b
LOCATION OF INSTALLATION: u 7
ti10 i
YEAR BUILT NO.OF
X COMPUTATION=
BEDROOMS RESIDENCE INFORMATION:
12
1980 or older = TOTAL DAILY FLOW
Fin 150 gallon per bedroom GARBAGE GRIND
1981 -1991 X 130 gallon per bedroom �� INSTALLED?
1992-present X 110 gallon per bedroom =
SPA OR HOT TU
PARCEL INFORMATION: INSTALLED?
✓ TOPOGRAPHY: Flat rolling
Steep slope %Slop
✓ SOIL NATURE: Sand
_____X-
- Loam,. Clay Other./ '
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL:
At what depth?4 _
✓ DOMESTIC WATER SUPLY:
Municipal Well, (If,well: Water supply from
system absorption is a se tic
PERCOLATION TEST: Rate is ft.)
✓
per minute 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
TANK SIZE: ' �,a l 6 Y/rS r, ti approved subdivision).
"-------- ��LL�___GALLON (MIN. SIZE IS 1y
,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 �
02.
❑ SEEPAGE PIT(S) (WITH NO. 3 g �ft' Each trench �S X_
STONE) How many?
❑ ALTERNATIVE SYSTEM BedSize?
or other type?
❑ HOLDING TANK SYSTEM Total required capacity? '
Tank size?______&±. Number of tanks?__74m
'` NOTE: ALARM SYSTEM AND ASSOCIATED
APPROVED ELECTRICAL INSPECTION ELECTRICAL WORK MUST BE INSPECTED
INSPECTION...ONAGENCY. PLEASE REVIEW LIST BY A TOWN
For your protection,. ............ ....... PROVIDED•.::.....,....,.. :, •
pease note that pursuant to Section 136-29 of the Code of the Town m n --
permit or approval granted which is based unnn ,,,;., ..-__._ . .
fail, ro+.. ._-'--
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection ',iv-• L ( 12
Queensbury Building &Code Enforcement Arrive: a .6 .
•' • �D�•art: 2i - !T••.
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia ip 4.
NAME: TY x' PE' IT NO.: l r 7 k)
LOCATION: 2 ""'"rn1 1 t r d. 4-vv-e t SPECT ON:
RECHECK:
Comments and/or diagram
Soil T •- :-m/ Clay
T •- of Water •• _)Well Water
Wates'' on distance { 0 ft."t" V >AV W)
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length tri N ft.
Length of each trench ). ft.
Depth of trenches r17.---2-ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank LI" Q JC_ EL1h 1136
Tank to Distribution Box 4 t ;3)0 Z "kb
Distribution Box to Field/ Pit k Qb Q •
Opening Sealed: _N
End Cap _N
Inlet/Outlet Pipes&Baffles Y— N
Location/ Separations AS,p� IT
• Foundation to tank �.
Foundation to absorption ft.
-•-ration of Pits ft.
04nforms as •z •I• • - i N
Engineer Report a ► primul
Location of System on Property:
Front Rear eft Side Ri•ht Side Middle Front 60-Idle Rear
s
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
Pipeline Specialists JOB
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