2002-120 TOWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CER"IIFICATE OF COMPLIAN,CE
Permit Number: P2002012.0 Date Issued: Wednesday, February 27,2002
This is to certify that work requested to be done as shown by Permit Number P20020120
has been completed.
Tax Map:Number: 523400-296-010-0001-027-000'0000
Location: 44 WINCREST Dr
owner: DANIEL&CYNTIRA BURKE .
Applicant: DANIEL&CYNTIBA BURKE
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: P20020120 Application Number: A20020120
Tax Map No: 523400-296-010-0001-027-000-0000
i
Permission is hereby granted to: DANIEL&CYNTHIA BURKE
For property'located at: 44 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 Building Codes and the.Queensbury.Zoning
Ordinance. Twe of Construction Value
Owner Address: DANIEL & CYNTHIA BURKE Septic Alteration Residential
44 WINCREST Dr Total Value
QUEENSBURY,NY -12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY.NY
Plans&Specifications
2002-120
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID'- THIS PERMIT EXPIRES: Tuesday,February 25,2003
(If a longerperiod is required,an application for an extension must be made to thee-code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at e :fT8�gp ee sb , on ay,February 25,2002 -
for the Town of Queensbury.
SIGNET?BY Q may
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbilly 742 Bay Road Queelisbi"-.V,NJ' 12804 (518) 761-8256
1. OWNER INFORMATION:
...................I........................... .............I...............................................................
Location of installation: Office Use
Tax Map No.
Owner's Name: e,,, Cp Fee P.idC::���
Pr( .-/f=D I............................... .......................
—
Address: C
FER 20G2
2. INSTALLER'S NAME 7-0 iVN 9
ffi No
ISSURY
3. RESIDENCE INFORMATION:' (circle year of dwelling,, indicate It be(irooniO afidQ�jni Q ftly if (?/'
bedroonts with applicable gallons pet-bedroom to equal total r1ai1j,jlolt,)
Year of House: No. of Bedrooms x Computation Total Daily Flo
1980 or older x ' 150 gal/bdrin = 7
1980- 1991 x 130 gal/bdrin
1991 -pi-escut
x 110gal/bdriii
Garbage-Grinder Installed yes_ / no All
Spa or Whirlpool Installed yes no-:�
4. PARCEL INFORMATION: (circle applicable inforillatioll &indicate measurements)
Ts99mrayhy S a
ure rot end Water
r Bedrock or Impervious Material E)
��,,t-,S�J2y
curd I what depth at whit depth 1';11ic,�-La
ain 'et Steep Slope clay If well; water*supply
—%.Vlope other
filn
depth: absorption
any septic-sjateni
absoiption is
other
Percolation Test: (To be completed by licensed professional engineer or architect)
t)
ininute per inch
5. PROPOSED SYSTEM: For New Copstniction: All individual sewage disposal systems must be desigiicd by.) licensed
professional engineer or architect(unless installed in a Planning 13oarda1-j)rovcd subdivision). Add 250 gallons to the size
of the septic lank and leach field for each Garbage Grinder, Spa or Whirlpeorl'ob.
Septic Tank: Z e—ogallon-(min. size 1,00agal.)
Tile Field: each trench ft. Total System Length:�,q 6 J1.
SeePagePit(s): number of size ofeach: _fl. by_fl.
Size of Stone to be used: depth or thickness el
Bed System Size: x
Alternative i System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each:_gallons /TOTAL Capacity: gallons
lVote. 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 tile Code of the'Town
of Queensbury, any permit or approval granted which is based upon or is granted in
reliaime upon any material it,isrepresentation or failure to make material Pact or
circumstance known by or on behalf of all applicant,shall be void.
I have read Uro regulations wil.h respect to.this application and agree to abide by Utcso and atl
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
� 9:nature of responsible 1 ble person Date
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