2003-670 TOWN OF 'QUEENSBURY
742 Bay Road,QueensbmT,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICAT E"OF COMPLIANCE
Permit.Number, , 20030670 Date;Iss'.0 Friday;August 15,2003
his.is to_certify thatwork requested.to.be.done as shown by:P.emt Number P20030670
has been completed,
Tax Map Number:. 523400-301-007-0002=030-000-0000
Lkation:' . 238 AVIATION Rd
Ow0r: 7
JOHN D ALDEN
Applicant, .. . JOHN D ALDEN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential :- TOWN N QUEENSBURY
Di eetor 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: P20030670 Application Number: A20030670
Tax Map No: 523400-301-007-0002-030-000-0000
Permission is hereby granted to: T014N D ALDEN
For property located at: 238 AVIATION Rd
in the Town of Queensbury,to construct ot`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 D ALDEN
C/O BUENA VISTA PARK •• Septic Alteration Residential
,Total Value
23 LAKE SHORE Dr z
WILLSBORO,NY 12996-4051
Contractor or Builders Name../Address; ( ! -�, Electrical Inspection Agency
I.R.S. SEPTIC
2 LOWER WARREN STREET
OTJF,ENSBURY.NY
' d
Plans&Specifications i
2003-670
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
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$25.00 PERMIT FEE PAID-THIS PERMI+EXPIRES: Saturday,August 14,2004
(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 the of Quee bu T ursday,August 14,2003
SIGNED BY _ for the Town of Queensbury.
Director of Building&Co e Enforcement
Application for Perinit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
.............................................................. ....................................
Office Use
Location of installation: 3r 4 C -CA- 7,�,
C)3
File Permit No. -00
Tax Map No.
Fee Paid
Owner's Name: A
=13
................ ............ ..............................................
Address: C
2. INSTALLER'S NAME
A- PHONE NO.
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
V
1980 or'older x 150 gal/bdrm.
1980- 1991 x 130 gal/bdrm
1991 -present x 110 gal/bdrm AU .3 2003
Garbage Grinder Installed yes, no* TONMI Or-QUEENSBURY
ID CODE
Spa or Hot Tub Installed yes no
4.* PARCEL INFORMATION:' (circle applicable information&indicate measurements)
T,gW"a hy Sml Nature Ground Water Bedrock or Impervious Material Domestic Water Skipply
(Fla
-)/ - s at what depth at whia depth municipal
-Aolling `75am —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: gallon min. size 1,006 gal.)
-
Tile Field: each trench ft. Total System Length:
Seepage Pit(s): number Of----L— size of each: -4�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 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.
%'S`ignature of respor(siffle person Date
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Septic Insp'Qction Rd port
Office No.(518)761-8256 Date Inspection request received,
Queensbury Building&Code Enforcement 'Arrive: aM&/ 7art7t-V-- T- 'am/pm.
742 Bay Rd., Queensbuiy,NY 12804 Inspector's Initials:
NAME: - PERMIT NO.:
LOCATION:
INSPECT ON: 32!
RECHECK:
Comments and/or diagram
Soil Type:( San se?folm lay
Type of are Municipdl Well Water '
Waterlinr
ep
ea' ti Istance
Well separation distance
Other,wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
See ge Pits: Number
Size:
Stone Size:
Piping Si4q, TypHg,A,
Building to tank
Tank to AX
Distribution Box rield/Pit
O ening Sealed: (Y/NI Partial
Location/Separations
Foundation to tank
Foundation to abs2_Ttion
Separation of Pits
Conforms as per Plot Plan' V�y N
Location of System on Property:
Left
Front ear Left Side Right Side
Middle ront iddle Rear
S 'Stem U St
Use Stat s:
Approved
Partial Approved and needs to be re-inspected,please call the*Building&Codes Office
Disapproved
L:\SucHemingway\Building.Codes.Inspection,FORMS\Septic Inspection.Report.doc January 28,2003
"I have seen or observed, or b,e i e v
r_ ,�,�' hn objects tfs sch as ='souses, wells, trees,sfenc vidence of,
Personally docL'rnLnt' I also represent that I have
BUILDING & D, DEPT. mews, reu „`' d►stances set forth on the diagram.,,
REVIEWED BY ,
' SIGNA RE
LATE
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