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2003-960 M TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NTY 12804-590.2 (518)761-8201 Community Development-Building&Codes (518)761-8256 . CERTIFICATE -0-F COMPL IANCE w..._. Petuit Numbers :-P20030960.. : Date Issued;: Monday,August 16,2.004 a cerdfy that,work request ed.tubeione as-shawri.by I'exmit Number r.P2.0030960 �_ has been:completed. Tax Map Number:. _ 523400-296-013-000:1-040-000-0000 Location; 7 WINCREST Dr Owner. PETER&LISA ZULAUF, Applicant; PETER&LISA ZULAUF 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: P20030960 Application-Number: A20030960 Tax Map No: 523400-296-013-0001-040-000-0000 Permission is hereby granted to: PFTFR &TJSAZTJT,ATJF For property located at: 7 WINCREST 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 Budding Codes and the Queensbury Zoning Ordinance. Tvoe of Construction Value Owner Address: PETER&LISA ZULAUF Septic Alteration Residential CONTE, LINDA Total Value 7 WINCREST Dr QUEENSBURY,NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2003-960 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 19, 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 w f Quee b sday, November 19,2003 SIGNED By' for the Town of Queensbury. Director of Budding&Co e Enforcement Application for Permit--Septlo Disposal System Town of Queensbury 942 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: ,� r^ Office use Location of installation: y �'� e�' l blei f� j� y� Tax Map No. / / i File Permit N0cy)_S q6o , � �, Lf � t Owner,s Name: � � Fee Paid ' ...,, >>� �� ,_.,... _....,.... ....._......_.......... Address: V 2. INSTALLER'S NAME : !/! C,'✓ a4C L 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_fl Year of House: No of Bedrooms x Computation — Total Daily Flow 1980 or older x 1.50 gal/bdrm = 0 J R 1980— 1991 x 130 gal/bdrm — e�� 1991 —present x 110 &I/bdrm -- 0 0 Garbage Grinder Installed yes / no � AUUfL Q(Pr' 3 Spa or Plot Tub Installed yes no�� ®�� RS` 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) r T h S ature ound Wa er Bedrock Im ervia s Material r)oxne6tie Water Sunply 1 t son at what depth at what depth .Rolling- oam feet feet Steep slope clay tfwell;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 Ieach field f r each Garbage Grinder,Spa or Whirlpool Tub. Septic Tank: F'kl4'7/ p � g-a11an(min. size I,t?t}D gal,) Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s) number of �j size of each; /O ft, by y ft. Size Stone Stoe to be.used: # 4.3. / depth or thickness � feet Bed System Size: x Alternative System: length andlor size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons l 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 wi ect to this application and agree to abide by these and all" require nts o the Town of Q ee ury Sanitary ewage Disposal i nature of res ibte person Date J r00/I00 01 bvd ££*£T 'ails. £OOZ/TO/LO Septic Inspection Report Office No. (518) 761-8256 Date Inspection quest eceive Queensbury Building&Code Enforcement Arrive: a D prn 742 Bay Rd.,Queensbury,NY 12804 Inspectoi's In NAME: RMIT NO.: LOCATION: INSPECT ON: RECHECK: Comments and/or-diagram. Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. C Well separation distance Other wells: Absorption Field: Total length ft Length of each trench ft. Dqpth of trenches ft. Size of Stone -Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field t Pit Opening Sealed: Y/NI Partial 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 Rear Left Side Right Side Middle ont Middle Rear System Use S tus: Us. Approved Partial Approved and needs to be re-inspected,please call the'Building&Codes Office Disapproved L:'SueHemingway\Building,Codes.Inspection-FORMS\Septic Inspection Rcport-doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Ins ectioni ------ 'I r Ues' Queensbury Building&Code Enforcement 'Arrive: "., ---a art: a in VC-A5- 742 Bay Rd.,Q b NY 12804 Inspector's Initials: NAME: 7RZ ZUU:kklll� PE S fNO.: CD CTO LOCATION: -7 LA-2i AQI�2,-Rff INS CT ON: RECHECK: Comments and/or diagram Soil Type: Sand Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. V--- 'ED --X-6 Depth of trenches ft. \3 Size of Stone Seepage Pits: Number Size: x V)VT Stone Size: Piping Size yype OT Building to tank Tank to Distribution Box Distribution Box to Field Pit Opening Sealed: Y/NI Partial Location/Separations Foundation to tank Foundation to abso tion _§eparation of Pits Conforms as per Plot Plan 'Y_N %41 Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Stat Approved Partial artial Approved and needs to be re-inspected,please call the'Building&Codes Office Disapproved 7� L*\SueHeming,A,ay\Building.Codes.Inspection.FOR-MS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection re"receiQueensbury Building&Code Enforcement Arrive: `",tJi at: /per742 Bay Rd., Qu buly NY 12804 ' Inspector's Initials NAME: > PEf/ IT NO.: C)LOCATION: 1NCT ON: -a 3 RECHECK: Comments and/or diagram Soil Type- San, /- rn lay Type of Water: unicipal ell Water Waterline se ar nce Well separation distance Other wells:Absorption Field: Total length Length of each trench Depth of trenches Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size T e Building to tank Tank to Distribution Box Distribution Box A' Field Pit Opening Seale Y/ a Location/Separations Foundation to tank fit. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N ' t _ Location of System on Property: 1 Front ar Left Side Right Side Middle Front le Rear Sys se Status• , _Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:'w"ueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 TOWN OUSE VSau . Bt11L,CDl G.�4,NC9 GC? 1 j 6 UILDING C REVIEWED Q ATE ro "I have seen or observed, or believe I saw evidence of, all ob;ects such as houses; wells, trees, fences, etc., Ishown on this doc u ant. I also re esent that I have . Personally, moas:r: tii, distant set forth on the diagram." SSICNATE DATE