2003-435 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: P20030435 Date Issued: Thursday,June 19,2003
This is to certify that work requested to be done as shown by Permit Number P20030435
has been completed.
Tax Map Number: 523400-288-016-0001-036-000-0000
Location: 74 NORTHWOOD Dr
Owner: JAMES&HOLLY MARKWOOD
Applicant: JAMES&HOLLY MARKWOOD
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
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: P20030435 Application Number: A20030435
Tax Map No: 523400-288-016-0001-036-000-0000
Permission is hereby granted to: JAMES &HOLLY MARKWOOD
For property located at: 74 NORTHWOOD 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: JAMES &HOLLY MARKWOOD Septic Alteration Residential
74 NORTHWOOD Dr Total Value
LAKE GEORGE,NY .12845
Contractor or Builder's Name/Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET '
OUEENSBURY,NY
Plans&Specifications
2003-435
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,June 19,2004
`(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of die Town of Queetsbury before the expiration elate.)
Dated at the T n of eens &tJ�tme19,2003
for the Town ofQueensbury.
SIGNED BY
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
.........................................................
At
Location of installation: -#- Office Use
7
File Permit No.03 `/
Tax Map No. aS
Owner's Name: t/ .;k r& Fee Paid
0�2a ..............................................................................................................
Address: IJ
2. INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of
I bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = —Total Dail v Flow
1980 or older x 150 gal/bdrm =
1980- 1991 x 130 gal/bdrm- = L/
1991 -present x 110 gal/bdrm = 7RECEIVED
Garbage Grinder Installed yes no JU14 1 g 2003
Spa or Hot Tub Installed yes no
TO'WN-OF QUEENSBURY
BIJILDING ANb,�ODE
4: PARCEL INFORMATION: (circle applicable information&indicate measurements)
a h ature Ground Water Bedrock or iWervious Material Do r Su ly
�te ..
Fla san at what depth I a, hat epth Kn-rl cipmal--,
muni *
ng am eet
slop,
rl a
Steep slope clay other
slope other if well; water supply
from any septic-system
depth: f absorption is_ft.
Percolation Test: (To be completed by licensed professionalengineer or architect) other-
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: gallon (min.size 1,000 gal.)
Tile Field: each trench_j?. Total System Length:
Seepage Pit(s): number of-—a— 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
Mote: Alarm System and associated electrical work must be inspected I 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.
dcu.3"
Si attire of sibi
b-ff t6 re resp e person Date
200
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building& Code Enforcement 'Arrive: am/p Depart: -L., UV am/pm
742 Bay Rd.,Queensbury,NY. 12804 Inspect is Initials:
NAME: PERMIT NO.: 3
LOCATION: ........
RECHECK: INSPECT ON: 0-3
Comments and/or diagram
Soil T e: Sa lay
Type of Water:/Munici_ipdl Well Water
Waterline sepal distance
Well separation distance ft.
Other wells:
Absorption Field: Total length
Length of each trench
Depth of trenches
Size of Stone
-See�page Pits: Number
Size: x
Stone Size:
Piping Size /Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit 'it
Opening Sealed: Y/NI Partial
Z
Location I Separations,. F/ ,
Foundation to tank '/V -ft.
Foundation to absorption Z'o ft.
Separation of Pits ft.
Conforms as_per Plot Plan N
-Location
o
f stem o
t
emo ro
perty:
Front Rea Left Side R ightSide
Middle ont fiddle Rear
8 stem
Use
tat
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
"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
persona easured the distances sat forth on the diagram"
SIVATDRE DATE
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