2005-007 TOWN OF QUEENSBURY
742 Bav Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050007 Date Issued: Thursday, January 13, 2005
This is to certify that work requested to be done as shown by Permit Number P20050007
has been completed.
Tax Map Number: 523400-296-017-0001-006-000-0000
Location: 16 GREENWAY Dr
Owner: GRIFFITH & CATHERINE PARRY
Applicant: GRIFFITH & CATHERINE PARRY
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System !x
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 Q l
1. OWNER INFORMATION: _ ,....................................................... ...............�......................
... ..�..............;
Office Use
Location of installation:
File?ermit No.
Tax Map No.
Owner's Name: �rC�g-r i� cl g
Address:,
TOWN 0
2. INSTALLER'S NAME 4 N�= �r✓ BULL
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 Daily Flow
1980 or older x 150 gal/bdrm = _ G'
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes,
Spa or Hot Tub Installed yes_.__
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Toj2oaraDhy Soil Nature Ground Water Bedrock or Im ervious Material . Domestic Water Soply
sa-n�' at what depth at what depth municTW
o ling mn feet feet we
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.
Sept TEk: 14- c)' gallon(min. size 1,000 gal.)
Tile Field: each trench ft. Total System Length: ft.
Seepage Pit(s): number of size of each: � ft. by ft.
Size of Stone to be used: # / depth or thickness feet
i
Bed System Size: x
Alternative System: 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
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 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.
Si re 4f responsible person Date
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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050007 Application Number: A20050007
Tax NIap No: 523400-296-017-0001-006-000-0000
Permission is hereby granted to: GRIFFITH& C;ATHF,RINF.PARRY
For property located at: 16 GREENWAY 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: GRIFFITH& CATHERINE PARRY
16 GREENWAY Dr Septic Alteration Residential
Total Value
QUEENSBURY, N.Y. 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
01 TEENSBURY SEWER
NY 12804-0000
Plans&Specifications
2005-007
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, January 14, 2006
(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 Toyrror%" ueensb^; T rsday, January 13, 2005
a :
SIGNED BY >''* ° for the Town of Queensbury.
Director of Building& ode forcement
Septic Inspection Report
Office No. (518)761-8256 Date Inspection r ec �S
Queensbury Building&Code Enforcement Arrive: part:
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi
NAME: r / IT NO.: 0 0 7
LOCATION: —e, SPECT ON:
RECHECK:
Comments and/or dia r
Soil T San Cla
Type of unit' ell Water
Waterline se ara ' istance V ft.
Well separation distance / ft.
Other wells:
Abs o tion Field: Total lengthft.
-Length of each trench ft.
-Depth of trenches ft.
Size of Stone
-Seepage Pits: Number Z
Size: x
Stone Size:
-Piping Size Type
-Building to tank
Tank to Distribution Box wC
Distribution Box Kield/Pit
Opening Sealed: Y /Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption-
-Separation of Pits
Conforms as per Plot Plan Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front iddle Rear
System Use Stat4s:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
LASueHemingway\Building.Codes.Inspection.FORMS1Septic Inspection Report.doc January 28,2003
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