2003-503 TOWN OF,QUEENSBURY
742 Bay Road,Queensbuq,NY 12804-5902 . (518}761-8201
Community Development-Building&Codes (518)761-8256
rUD
OF COMPLIANCE .
Permit Number, P20030503 Date Issued: Wednesday,July 30,2003
This,is to certify that work requested to be done as shown-by Permit Number P20030503
has been completed.
Tax Map Number:' 523400-302-014-0002-071.0001-0000
Location: 4 LINDEN Ave
Owner: JOHN&JILLANE WEBER
Applicant: JOHN&JILLANE VEBER .
This structure may be occupied as a:
By Otder of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Nector of Building&Code Edoteement .
f TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030503 Application Number: A20030503
Tax Map No: 523400-302-014-0002-071-000-0000
Permission is hereby granted to: JOHN&JIILANE WEBER
For property located at: 4 LINDEN 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. T"e of Construction Value
Owner Address: JOHN&JILLANE WEBER Septic Alteration Residential
4 LINDEN Ave Total value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans&Specifications
2003-503
SEPTIC ALTERATION AS APPLICATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 03,2004
(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 a Tow of Q ns ury; day,July 03,2003
SIGNED BY for the Town of Queensbury.
ur1'
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:
.......... ...............
Office Use
Location of installation:
Tax Map No. File Permit No. C013
A.j Fee P- L=C.,o t _
Owner's Name: e ,_
................ ......... .. . ....
............
Address: 'JUL. 0 2ow
2. INSTALLER'S NAME -"rOWN op Qtj
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
x 150 gal/bdrm
—1991
x 130 gal/bdrm
1991 —present x 110 gal/bdrm
Garbage Grinder Installed yes 10937-1
Spa or Hot Tub Installed yes_ CiF
4.' PARCEL INFORMATION: (circle applicable information&indicate measurements)
Too eranhv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Suvolv
at what depth at what depth
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.
&Y Septic =T-
Y- �: /-C122,r) gallon min. size 1,000 al-)
Tile Field: each trench ft. Total System Length: Z60 ft-
Seepage Pit(s): number of size ofeach: ft. by_ft.
Size of Stone to be used: # depth or thickness feet
Bed System Size: x
Alternative System: 'I--Cf e,-x length and/or size 7-
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.
Sig fur o son responsible per ' Date
Septic Inspection Report
Office No. (518)761-8256 Date Inspection re st ecei ed:
a 1
QueensbLiry Building&Code Enforcement Arrive: p part: a i
s:
742 Bay Rd., Queensbui y,NY 12804 Inspector's Initiff?
NAME: IT NO.: 0 3
It - 2/
LOCATION: SPECT ON:.
RECHECK:
Comments and/or dia am
Soil Tne 'S oam lay
Type of ater:tMuniciD Well Water
Waterline s-par istance
Well separation distance
Other wells: ft.
Absorption Field: Total length
Length of each trench
Depth of trenches
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank - IA-1,xzC-2
Tank to Distribution Box 14 1" —A)
Distribution Box;b--Jjiel Pit
Opening Sealeff V-X/Partial
Location/Se orations
Foundation to tank
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan �Y_N
Location of System on Property:
Fr ear eft Si zght Side
Middle Fr t Middle Rear
t
System Use S St us:
7 S2:7Approved
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
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i,
"I have seen or observed, or believe I saw evidence of,
all � ifCeS,etc.,
shown on this document, I du i6pjd�ijn, cw,t! hove
personally measured the distances set forth on the diagram.'
IGNATURE DATE
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