2002-030 ' -OW, OF VEENS JRY
'742 B#Road,Queensbury,NY 12804-5902 �(518)761-8201
Community Development Building&Codes (518)761.826
" .1. Nut' 'CER'I IFIC.AT� aF C0� L
e
Permit Number.:� PHNOM Date Issued: Tuesday,January 15,.2002
This �to certify that,work requested to be done:as shown b Permit Numbex ,f
y P2.002,oM
-has beenlcompleted.
Tax Map Number: 523400-301.013'0002 011-00070000
Locations 14 PEGGY ANN..Rd
Owner, MICHAEL TOWERS;
Applicant:. - . .
DAVID.&KATKLEEN CHESNEY
This structure may be"' ccupied as as ;
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: P20020030 Application Number: A20020030
Tax Map No: 523400-301-013-0002-011-00070000
Permission is hereby granted to: DAVID &.KATHLEEN CHESNEY
For property located at: 14 PEGGY"ANN Rd
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. TTpe of Construction Value
Owner Address: DAVID &KATHLEEN CHESNEY Septic Alteration Residential
14 PEGG.Y ANN Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
CONDON SEPTIC&DRAIN SERVICE
Plans &Specifications
2002-030
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID THIS PERMIT EXPIRES: Wednesday,January 15,2003
(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 Que sbury; Tuesday,January 15,2002
SIGNED BY r for the Town of Queensbury.
Director of Boil & e Enforcement
Application for Permit—Septic Disposal System -
Town of Queensbury 742 Bav Road Queensbury,NY 12804 (518)761-8256
1. OWNER INFORMATION: ..................._............_................_.....................___.._ .................
Office Use
Location of installation: I L `-FIEM 1 � ` Q�ay
�� File Permit No.
Tax Map No. 0 Q
Fee Paid .
Owner's Name: MV5° >
Address: It Jt J \
2. INSTALLER'S NAME Cc)"—��N S�Yl Ga` i7'Iti� PHONE NO.� I�
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
1980 or older x 150 gallbdrm = J
1980— 1991 x 130.gal/bdrm
1991 —present x 110 gal/bdrm dAN
5 zoo
Garbage Grinder Installed yes_ / no X TOW/V O EIV2
Spa or Whirlpool Installed yes_ i no '-A sU/LD1fyG giyf)Cp E
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
TgpoUa-phy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
hat and at what depth at what depth munici al'
Rolling loam 1/4_feet N Lj 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: i R 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: 1C3Da_gallon (min. size 1,000 gal.)
Tile Field: each trench —')0 ft Total System Length: a�C 1t
Seepage Pit(s): number of 7,J J/2�- size,of each: ft. by ft.
Size of Stone to be used: # �_ / depth or thickness feet
Bed System Size: x
Alternative System: length andlor size .
6. HOLDING TANK SYSTEM: (i£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.
OVA
Signature of responsible person Date
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DATE,
SIGNATURE l .
1; • ; , TOWN OU" URY
BUILDING PT,
REVIEW B
ti21, i DATE