2003-928 TOWN NQUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community;Development-B'uilding&Codes (51$)7618256
CERTIFI ATE C OFCOMPLIANCE
Permit Number:. P20030928 Date Issued: Tuesday,November 04, 2003
Thia is to certify that work requested to be done as shown by Permit Number P20030928
has-been completed.
Tax Map Number: 523400.302.0.14-0003-024-000-0000
Location: 35 PARK VIEW Ave
Owner: MICHAEL&SUSAN GILBERT
Applicant: MICHAEL&SUSAN GILBERT
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Directoi of Building&Code nforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDMG PERMIT
Permit Number: P20030928 Application Number: A20030928
Tax Map No: 523400-302-014-0003-024-000-0000
Permission is hereby granted to: MTCHAET,& STJSAN(TIT,13FRT
For property located at: 35 PARK VIEW 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
Ordi,nance. Type of Construed Value
Owner Address: NUCHAEL& SUSANGILBERT Septic I Alteration Residential
3 5 PARKVIEW Ave Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2003-928
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,November 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 the TZ7ueens7; Zjay No
vember 03,2003
t
SIGNED BY for the Town of Queensbury.
Director of Building Code nforcement
Application for Permit—Septic Disposal CIF/
6 8 V 4%f�M 4'��03-9w
Town OfQueenaburY 742 Bay-Road Queensbuy,NY .12804 U
2. OWNER INFORMATION- 7[,�J-8256
'y
?'Diw V
office use
to
OF
Location of Installation: pC
Tax Map No.
Owner's Name: Fee Paid
.............
Address: 1P r-4&1eJ"eua
2. INSTALLER'S NAME fj PHONE No.?9 7cM
�y in
3. RESIDENCE INFORMATION: (circle y r of dwelling,indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year o—House: Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrin =
1980- 1991 x 130 gal/bdrm =
1991 -present x 110 gal/bdrm
Garbage Grinder Installed yes no
Spa or Hot Tub Installed yes_ no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
To aalohv_ -S 4 J e Ground Water Bedrock or Imnervious Material D=12stic Water SUD01V
sand at what depth at what depth unicipa M 9 ------feet if
Steep slope clay if well;water supply
—Vo slope other
fromfromany septic-system
4
depth: absorption fs_ft.
Percolation Test- (T&be-completed by licensed professional engineer or architect) other
Rate: minute per inch
5. PROPOSED SYSTEM; For New Construction: All individual sewage disposal sysxexxxs must be designed by a licensed
professional=gixxeer or architect(unless installed in ii Planning Board approved subdivision). Add 25O gallons to the size
of the septic tank and leach field for each Garbage Cninder.Spa or Whirlpool Tub.
t 000
Septic Tank: gallon(min. size J'000 gal.)
LY
Me Field: each trench 410 1 Total System Length:
of
111
Seepage Pit(s): number size of each. ft.
—W 4--
Sizc,,gf Stone to be used: 4 �'a depth or thickness feet
Bed System Size: x
Alternative System; length and/or size
6. HOLDWO 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 13629 of the Code of the Town
of Queensbury, any permit or approval grarxTed 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 regulationrw-hb respect to this,application and agree to abide by these and all
require, entg f the Town f Q eensbury anitary Sewage Disposal Ord
7;,A3
qnature of responsible person Date
T00/T0001 XVd CC:CT MI-I COOZ/TO/LO
Septic Inspection Report
Office No. (518)761-8256' Date Inspection re st ce' U �Q
Queensbury Building&Code Enforcement Arrive: m/p art: %11b Ka
Tr-
742 Bay Rd.,Queensbury,NY 12844 _Inspector's Ini ls`
NAME: \ � r P IT NO.:
7
LOCATION: SPECT ON:
RECHECK:
Comments and/or dia m
Soil T e: Sa oam lay
Type of Wate • uni ' 11 Water
Waterline separa on 1stance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total lengthy ft.
Length of each trench
.Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size ' Type
Building to tank
Tank to Distribution Box " �r
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption Qe t.
Separation of Pits x ft.
Conforms as per Plot Plan V Y N
Location of System on-Property:
Front Rear Left Side Right Side
Middle Fro t Middle Rear
System Use S tus:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
LASueHemingway\Huilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
1�I
CP
RECEIVED
-:04 r1-9 J NOV 0 3 2003
TOWN OF QUEENSBURY
BUILDING AND CODE
�01
El
TOWN9 CIF t �EDN".-s�AR
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BUILDING S � r . 30r
REVIEWED BY L
DATE „k...�..k �- -
n'
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
wn an this doc t. I also repres nt that I have
per a , liy measur t e istan for an the diagram,""
SIGN U E DATE