2010-223 TOWN OFQ UEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100223 Date Issued: Tuesday, December 11, 2012
This is to certify that work requested to be done as shown by Permit Number P20100223
has been completed.
Tax Map Number: 523400-303-020-0001-079-000-0000
Location: 24 QUEENSBURY Ave
Owner: TERENCE J LORD
Applicant: DAVID BUTLER
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
(-3 j
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
FOS 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100223 Application Number: A20100223
Tax Map No: 523400-303-020-0001-079-000-0000
Permission is hereby granted to: DAVID BUTLER
For property located at: 24 QUEENSBURY 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: DAVID BUTLER
DIANE LEE Septic Alteration Residential
24 QUEENSBURY Ave Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-223
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, May 12, 2011
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the T o ;
ee u i d esday, May 12, 2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
303` 2 O /��q OFFICE USE ONLY ',,`
TAX MAP NO. 0223
ZL)
PERMIT NO. PERMIT FEE
,
APPROVALS: ZONING ,i , ilii[.
TOWN CLERK ,
,
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. /��
OWNER: ,Ct4G':ai />G f/PL L. INSTALLER: (/✓. 1/1/, /✓,'p,•/% L:2CRI//1/in,L)
ADDRESS: y odeeN$/j K'c A/e ADDRESS: /G0 f20/,49SA Rel GA,WeGUS'c("Ale /✓,X/zj4/6
PHONE NOS. 7 .3 7/C':5 PHONE NOS. 9,2C, CSS`
LOCATION OF INSTALLATION: V 'v e e-+/514zie/ /9Ut'
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
BEDROOMS
1980 or older ? X 150 gallon per bedroom = GARBAGE GRINDER
y� - INSTALLED?
1981 -1991 X 130 gallon per bedroom =
1992 present X 110 gallon per bedroom = SPA OR HOT TUB
INSTALLED?
PARCEL INFORMATION: /
✓ TOPOGRAPHY: Flat rolling / Steep slope %Slo
pe
✓ SOIL NATURE: Sand /7 Loam
Clay Other
✓ GROUNDWATER: At what depth? ii=
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? 7/=
✓ DOMESTIC WATER SUPLY: Municipal L/ Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is /
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 approved subdivision).
TANK SIZE: /OOO 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 POO ft. Each trench v2 X ..
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many?
Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELE
...........................................................................................
CTRICAL 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.
IP" t ) - (:)'d 14--
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection requ- e..:40,0, 7 g- , c l
Queensbury Building&Code Enforcement Arrive: 4:56 a (4211PO4.z••rt: /M' a IV
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: "
�t
NAME: 7 'LI& ti 'i' PE'- IT NO.: - '1/0- 3
LOCATION: '2 ' 4- _-- , PECT ON: —AM/ 't?
RECHECK:
Comments and/or diagram
Soil Ty • .L.oam/Clay
Type of Water: unicipal/Well Water
Waterlinesep ration 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 2-On ft.
Length of each trench ft.
Depth of trenches Z LlyJt.
Size of Stone Z
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank t- " ,b \-\C)
Tank to Distribution Box y,t\ h Or¢��-6
Distribution Box to Field/ Pit f y,« Q C. Y E
Opening Sealed: VY N
End Cap k./i' 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 tank !1A ft.
Foundation to absorption lc, ft.
Separation of Pitsft.
Conforms as per Plot Plan VY—N
Engineer Report and As-Built 'Y N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front RA Left Side Right Side Middle Front Middle Rear
stem Use S . is:
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 Report03 29 10.doc
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
�, Community Development- Building& Codes (518) 761-8256
Inspections per Permit
Permit# P20100223
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
05/12/2010 Miscellaneous Septic Alteration Residential JENNIFER HENDERSON Staff
Misc 2010-223
permit issued
05/19/2010 Septic Septic Alteration Residential JOHN O'BRIEN
Approved 2010-223
12/11/2012 Miscellaneous Septic Alteration Residential STAFF
Misc 2010-223
permit never closed out-CC issued
Community Development Office
Town of Queensbury • 742 Bay Rd.
Queensbury, Nezv York •12804 PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
SIDE PROPERTY LINE
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an ��l�lra:ts s+�;Lr As houses, wells, trees, fences,'etc.,
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SIDE PROPERTY LINE 1 SQUARE = 144i/FT.
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