2003-982 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12864-5902 (518)761-8201
Community Development-Building&Codes (518)761.8256
CEIRTA IFIC
ATE OF COMPLIANCE
Permit Number: P20030982 Date Issued: Juesday,December 02,2003
This is to certify that work requested to be done as shown by Permit Number P20030982
has been completed.
Tax Map Number: 523400-301-006-0002-051-000.0000
Location: 21 SWEETBRIAR Ln
Owner: DAVID&CATHERINE SWIFT
Applicant: 'DAVID&CATHERINE SWIFT
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Duector of Building&Code Enfor ment
N
TOWN OF QUEENSBURY
6
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030982 AppIkation Number: A20030982
Tax Map No: 523400-301-006-0002-05 1-00M000
Permission is hereby granted to: T)AVM &-CATRFRTN"F, SWIFT
For property located at: 21 SWEETBRLAR Ln
in the Town of Queensbury,to construct or place
at the above location M* 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.Coristruction Value
Owner Address: DAVID & CATBERINE SWIFT Septic, Alteration Residential
21 SWEETBRIAR Ln" Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
CTLENS FALLS NY
Plans&Specifications
2003-982
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,December 02,2004
(If-.A longer period is required,an application for an.extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To December 02, 2003
SIGNED BY n( T/ � for the Town of Queensbury.
Director of Building&Code Enforcement
03
•7
AppXica#on for Permit--Septic Dispp
Town of Queensbury 742 Bay Road Queensbury, flffffl�MP67 .
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1. OWNER INFORMATION: .
Office Use
Location of installation: r l"..e r
Tax Map No. / / TOWN iF w{+
Bit-iLD� ®.C®DE, 5- 0
Owner's Name: tf 10 J �/ �1 ��i..�... _... ...._....._...._.......w _. ..... ......... _.
Address: d 6zLr$vcrl� '
2. INSTALLER'SNAAM '�!.•S(�/rulr i ca J PRONE 140. '79,,) -7dX 7
3. RESIDENCE IhTFORNIATIQN. (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 t3gms --Qn ,itxatgota Total Daily
1980 or older x 1.50 gal/bdrrn
1980- 1991 x 130 gal/bdrm
1991 -present x 110 gal/bdrm
Garbage Grinder Tnstalled yes� / no
Spa or Rot Tub'Installed yes _ l no f/
4• PARCEL INFORMATION: (circle applicable information&indicate measurements)
dozon �
c ervi a at what depth at what depth loam et feet well
Steep slope clay 'zf well;water supply
—V.P slope other from any septic-system
depth: absorption is ft.
Percolation Test:, ( 0,be completed by licensed professional engineer or architect) other
Rate. minute per inch
5. PROPOSED SYSTEM; For New.Constructien: All individual sewage disposal systezus 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 Gunder,Spa ar WhirlpaoI Tub.
Septic Tank: . gallon (min. size 1,000 gal,)
Tile Field; each trench_ _.ft. Total System X.ength: ft.
Seepage Pit(s):- number of size of each; ft, by fr.
Size 9f Stone to be.used; # / depth or thiclviess feet
Bed System Size: Al x
Alternative System-, length and/or size
6. 1-101-Dn'T i TANK.SYSTEM: (if required)
Number of tanks: / Size of each gallons !TOTAL Capacity: gallons
Nate: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SICYNAT'OR.E &Il-TFORN ATION VOR RESPONSMLE,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 rMisrepresentation 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
requireme e Town of sbury Sanitary Sewage Disposal Ordinance.
g ature of rasp_ nsibte person Date
T00/T00(7j XVd St':t:T aIIL £OOZ/TO/LO
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection requ ce'ved: /"Z///0 S-
Queensbury Building&Code Enforcement Arrive: p part:
742 Bay Rd., Queensbury, 12804 Inspector's Initi s:
NAME: RMIT NO.:
LOCATION:
SPECT ON: P/
RECHECK:
Lao
Comments and/or diagram
oa C
Soil T San as Jay
-DTe of r: �4unicipW Well Water
e�p
*Wa'teerl!ine�separatiori distance V ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench 11-c'ft.
Depth of trenches a ft.
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Pi in Size Type
Building to tank
Tank to Distribution Bov
Distribution Box ro7i o/Pit 2
Opening Sealed VNI Partial
Location/Separations
Foundation to tank
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan YN
Location of System on Property:
Front Rear Left Side Right Side
iddle Front iddle
S s 6m se se tat
Approved
pproved
Partial Approved and needs to be re-inspected,please call the'.Building&Codes Office
Disapproved
L:1SueHemingway\13uilding-Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
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"I have seen or observed, or believe I saw evidence of,
all objects such as houses, veils, trees, fences, etc.,
shown on tits Jo <-1rw3nr. I also represent that I have
maliy {�easU-e.' nr,. distances set forth on the diagram.'
SIGNATURE [SATE