2004-980 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20040980 Date Issued: Tuesday, December 28, 2004
This is to certify that work requested to be done as shown by Permit Number P20040980
has been completed.
Tax Map Number: _ 523400-296-009-0001-044-000-0000
Location: 23 TWICWOOD Ln
Owner: PETER WETTERSTEN
Applicant: PETER WETTERSTEN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
JW /7�
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040980 Application Number: A20040980
Tax Map No: 523400-296-009-0001-044-000-0000
Permission is hereby granted to: PETF,R WETTERSTEN
For property located at: 23 TWICWOOD Ln
in the Town of Queensbury,to construct or place
at the above location in accordance with application together wide plot plans and oilier information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Tyne of Construction Value
Owner Address: PETER WETTERSTEN
CE RIS BOCKO-WETTERSTEN Septic Alteration Residential
Total Value
23 TWICWOOD Ln
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
MORNMG STAR
Plans&Specifications
2004-980
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, December 27, 2005
(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 To o eensb tt y, December 27, 2004
1z
SIGNED BY for the Town of Queensbury.
Director of Building&Code forcement
Applibation for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: .........................................I................. ............ ......................................
Office Use
t NLocation of installation:
File Permit No.
Tax Map No.
Fee Paid
Owner's Name- oj&—L-it�
.........................................................................................................
Address:
2. INSTALLER'S NAME 573,-, PHONE NO. �P,32 2CM
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 = cow
1980- 1991 x 130 gal/bdrm =
1991 -present x 110 gal/bdrm. =
Garbage Grinder Installed yes no'!-- RECEIVED
Spa or Hot Tub Installed yes_ no
DEC ?, 3 Z004
4.' PARCEL INFORMATION: (circle applicable information&indicate measurements) SBURY
TOWN OF QUEEN
Too grgRhy SoiLhIaWre— Ground Water Bedrock or Impervious Ma&�Dl ND CO er Su lv
c� at what depth at what depth C�Cun—icia pT)
Rolling loam _feet feet well
Steep slope clay if well,water supply
%slope other from any septic-system
depth: absorption is
other
Percolation Test: (To be comp et.ed p
by-licensed rofessional 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: 0-1k? gallon (min. s6 00 1.)
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
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 13 6-29 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 Que nsbury Sanitary Sewage Disposal Ordinance.
/I-.101- 0
V<;ig4naturr'6iWo6Ab-1e person Date
' •�I`ptV 11 ��• ��ll(;t+l l.+il)Lil•�
Srtvc:T•s :uul �c:ws:�;c: Disposal (1,1131plet.
Appmulix C,
i
n 1 ��►t)Ii.I'''1'1c2�1 I�'I EI,I.�
SliA)/1•ltNi' ON Ii:I�t�i,3lItI�Iti]I��ly'I`:i
r '
POND
y' FUL IN T!werZ• Gl tc'rvt .
.''114
' • i
1b91E f cf E �;.s'�'�' I'I l�:?vsr= G F
r
lit
i !, I ,, ! Sc r'T to yI
1 Ml ly.
F`lri.LC�
' trvnD
7, SIGNATURE &INFORMATION FO.kt SPUN;$ xsLZ � w
Z% V�`I 1CgiV•tlYV
1 1
Septic Inspection Report
Office No. (S 18)761-8256 Date Inspection re est L/�epa
ed:
Queensbury Building&Code Enforcement Arrive: m/prnrt: a prr
742 Bay Rd., Qu bury,NY 12804 Inspector's hiitials.,. I -
NAME: - _i 4-0-A PEe� IT NO.:
LOCATION: ; � T
ECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand oam/Clay
T e of Water: u icigg Well Water
Waterline se ara ' wee— ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number :; Z
Size:
Stone Size:
Piping Size Type
-Building to tank
Tank to Distribution Box ►� r;
Distribution Box t ield Pit 4�
O ening Seale Y a Ia
Location/Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Location of System on Property:
Front Re ,-'---Left Sid Right Side
Middle Ffon' Middle Rear j
System Use St tus•
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
SBL#•
Property)Location:
SKETCH OF`PROPOSED"WORK
Show the following:
* Neighboring Well Location * Streets /� Q
* House Location * Proposed Septic Location and Size /
* Distances to Property Lines and Any Water Courses on Property
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this document. I.also represent that I have ���
9F
personally measured the distances set forth on the diagram."
IGNATURE DATE
��. RECEIVE®
}k
1� DEC 2. :3 2004
TOWN OF QUEENSBURY
1.11 ° BUILDING AND CODE
v' )�'4I
BU MING O
�v
REV EWED BY �k
DAT
n