2002-196 TOWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
CEIR Ti. IFICATE 01F COMPLIANCE
Permit Number: P20.020196 Date Issued: Thursday,March 28,2002
This is to certify that work requested to be done as shown by Permit Number P20020196
has been completed.
Tax Map Number: 523400-308-016-0002-015-000-0000
Location: 383 CORINTH Rd
Owner: RITA HAY
Applicant: DENNIS MINER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building Code nforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020196 Application Number: A20020196
Tax Map No:' 523400-308-016-0002-015-000-0000
Permission is hereby granted to: DENNIS MINER
For property located at: 383 CORINTH Rd
in the Town c?f 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. Type of,Construction Value
Owner Address: RITA HAY Septic Alteration Residential
DENNIS MINER Total Value
383 CORINTH Rd
QUEENSBURY,NY 12804
Contractor or'Builder's Name Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2002-196
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00: PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday;March 28,2003
(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 th ow f Q ��ur3' March 28,2002
�r SIGNED BY — r8fty -for the Town of Queensbury.
Director of Building&Code Enforcement
Application far Permit—Septic Disposal System
Town of Queeiisbul y 742 Bay Road Queensbury,NJ'.12804 (518) 761-8256
1. OWNER INFORMATION:,
......................................................».....................................................
office Use
Location of installation: c y t n /
File Permit N.,Tax Map No.
j Fee Paid
Owner's Name: k e-
......................._............................»........................_.......................
Address: (r°_...gZar 771 J
2. INSTALLER'S NAME L%�� � Q
PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedrootn(s)and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No.*
o of 13edrootns x Computation = Total Daily Flow
T980 car older x 150 gal/bdrtn
1980- 1991 x 130 gal/bdnr► _
1991 -present x 110 gal/bdrun = -
Garbage;Grinder Installed yes
Spa or Whirlpool Installed yes / no: R � ?
TOWN OF Ot EENS13UR""
4. PARCEL INFORMATION: (circle applicable information+&indicate rnensuremdfits!91t, ,!`,"11- CODE
'T'opouranihv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
1�% s at what depth at what depth tTiunior
Rolling loam feet feet well
Steep slope clay if well; water supply
slope other from any septic-system
depth: absorption is JI.
other
Percolation Test: (To be completed by licensed prt feasional engineer or architect) ^�
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage-disposal systems roust be designed by a licensed
professional'engincer 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:''' gallon (min'. size 1,000 gal.)
Tile Field. each trench _ . Total System Length:
Seepage Pit(s): number of size ofeach: Jl. 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: (if required)
Number of tanks: / Size ofeach: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must-be inspected by a Town approved
electrical inspection agency. _
7. SIGNATURE &1NFORMATION 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 pern}it 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.ori behalf of an applicant, shall be void.
1 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.
sign 4tude of responsible person Date '
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It*1�'_ a nt our GmIS 1.
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i not be construed as• artin' 11
plans and specificat+on
�y;npliance with the coRY
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TOW
BUI ING T.
REVIE ED BY.
DATE
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111 have seen or observed,or believe I saw ev etc
of,
all objects such as houses,wells,trees,fences,
� shown on this document. I also represent that I have
personally measured the distances set forth on the diagram."
DATE
IGNATURE