2002-562 - TOWN OF QUEENSBURY FILE
742 Bap Road,Queensbuty,NY 12804-5902 (518)761-8201
Community Development -Building&Codes (518) 761-8256
CElRTIFICATE OF COMPLIANCE
Permit Number: P20020562 Date Issued: Tuesday, July 09, 2002
This is to certify that work requested to be done as shown by Permit Number P20020562
has been completed,
Tax Map Number: 523400-301-008-0001-089-000-0000
Location; 57 HELEN Dr
Owner: PETER&MARY MASTRANTONI
Applicant: PETER&MARY MASTRANTONI
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforc et
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 FILE COPY
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020562 Application Number: A20020562
Tax Map No: 523400-301-008-0001-089-000-0000
Permission is hereby granted to: PETER &MARY MASTRANTONT
For property located at: 57 HELEN Dr
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: PETER&MARY MASTRANTONI
57 HELEN Dr Septic Alteration Residential
Total Value
QUEENSBURY,N.Y. 12804
Contractor or Builder's Name/Address ;+ . 'Electrical Inspection Agency
JAY SWEET
NY 12904-0000
Plans &Specifications
2002-562
Septic Alteration
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 02,2003
(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 Town of Queensbury; Tuesday,July 02,2002
SIGNED BY for the Town of Queensbury.
!Fod0%6rCnt
Director /Building
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bav Road Queensbury,NY 128o4 (518) 761-8256 j
1. OWNER INFORMATION:
. ___..._.....___.
Location of installation: _..._. ...._..._........._....... Office Use .............
�
File Permit No.
Tax Map No.
Fee Paid
Owner
's s Name
- e
:
......_.._ ......
Address: JUL 022002
� � /-'V ®�IYV op,
2. INSTALLER'S NAME . \J, � -'� PHONE N t�IL
�0�3sMa COOS
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No.of Bedrooms x Computation = Total Dailv Flow
�1990 or oldPr� x 150 gal/bdrm = Z1
19$0— 1991 x 130 gal/bdrm =
1991—present x 110 gal/bdrm =
Garbage Grinder Installed yes
Spa or Whirlpool Installed yes
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topo�raphv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Suns_ lv
an at what depth at what depth C municipap
Rolling loam feet feet well
Steep slope clay if well; water supply
_%slope other from any septic system
depth: absorption is ft
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch -
5. 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). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank: f gallon(min. size 1,000 gal.) � ��� ��,,�
r
Tile Field: each trench ft. Total System Length" fl 'L&
Seepage Pit(s): number of size of each: ft. by ft
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: }Cu length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
i
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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
I have read the regulations with respect to this application and agree to abide by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
i
Signature of responsible person Date