2002-293 y
r` TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
v Community Development-Building&Codes (518}761.8256
CE RT IFICATE QF COMPLIANCE
Penr t.Numbef: P20020293 ',',' .Date Issued; Wednesday, May. 01,2002
This is to certify that work requested to be done as shown.by Permit Number P20020293
has been completed.
Tax Map Number: 523400.296-013-0001.073.000-0000 :
Location: 73 MONTRAY Rd
Owner: GRAYSON PROPERTIES,L.L.C.
Applicant: GRAYSON PROPERTIES,L.L,C,
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: P20020293 Application Number: A20020293
Tax Map No:, 523400-296-013-0001-073-000-0000
Permission is hereby granted to: GRAYSON PROPERTIES.L.L.C.
For property!located at: 73 MONTRAY 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. ' Type of Construction Value
Owner Address: GRAYSON PROPERTIES,L.L.C. Septic Alteration Residential
1004 CHESTNUT St Total Value
MECHANICVILLE,NY 12118-0000
Contractor or Builder's Name j Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LONER WARREN STREET
OUEENSBURY,NY
Plans &Specifications
2002-293
LOT 13 GRAYSON MOBILE HOME COURT
SEPTIC ALTERATION AS PER APPLICATION
f
.$25.00, PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,April 24,2003
(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 T of Qu nsbury; nesday,April 24,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit— Septic Disposal System
YbItyn of Qtivensbuiy 742 Day Road Queensbttrj;NY 12804 (518) 761-8256
1. OWNER INFORMATION: .......................................................................... .................................................
Oltice Use
Location of installation: File Pe -)nnit No.
Tax Map No.
Fee Paid cig:;51
Owner's Name: f/_11 f, I', !P. ................................ .................
......................................
Address:
*2 INST
ALLER'S NAME % PHONE NO.
(circle of dwelling,indicare ff bedrootn(v) and multiply .ff of
3. RESIDENCE INFORMATION:
bedrooms with applicable gallons per bedroom to equal total dallyflosv).
Year of Rousts No. of Bedrooms X Computation = Total Daily Flow
v
1980 or older x 150 galfbdrin = Csa -::RECEIVED
1!980— 1991 X 130 ga Vbdrtit =
11991 —present X 110 gnVbdrni APR 2
Garbitgo Grinder Installed yes l no 'TOWN OF QUEENSBURY
I
Spa or Whirlpool Installed yes no BUILDING AND CODE
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
Leal
olling
Steep
slope Clay tf well; ivatersupply
fi-oln alj.�septic-system
Zll slope other absorption is_fl.
depth: other
Percolation Test: (To be completed try poetised pro fessiotialetigltiecrorarclillect
njinitte per Inch
5. Pl�OPOSED SYSTEM: For New Construction: All individual sewage disposal systems tnus(be designed by h licensed
prorcssionil engineer or architect (unless installed ill a Illijurtitig Hoard.alVtoved subdivision). Acid 250 gallons to the size
of Ilic septic uuik and leach field for tacitGarbage(,tinder, Spa or Whit 11mol Tub.
Septic Tank: gall (i/lonin. size 1,000 gal.)
f/—
Tile Ftold:
each trench fl. Total System Length:
Seepage Pit(s): number of size ofeach: _ft. by
Size of Stolle to be tined: dept/I or thickness.
Bed System Size: X
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if 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'tote that pors%innt to Section 136-29 ortjio code of,the Town
arqueerisbtiry, any pormit or npprovni grnrited whicls is based uponor is granted in
reliance upollally Illaterint III isrepresetitatioti or rhiltisv to make-I material fact or
circtimstance knowit by or on beitntrurni, applicant. sliall be void.
I]love read tho regulations with respect to this nl7plicntion and agree to nbido by these and nil
requirements ofthe Town of Queensbury Sao,itory,Sewage Disposal ordinance.
Signature of responsible person Date
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"I have seen or observed, or believe I saw evidence of, e
all objects such as houses, wells, trees, fences, etc., A?IR
shown on this document. I also represent that I have
persona easured the distances set forth on the diagram
person, ea'sur
C SIGNATURE
IGNATURE DATE
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PL
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TOWN OF QUEENS ' URY
BUILUNG D T.
REVIEWEDA
DATE
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