2001-165 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010165 Date Issued: Thursday, April 19, 2001
This is to certify that work requested to be done as shown by Permit Number P20010165
has been completed.
Tax Map Number: 523400-279-000-0001-053-000-0000
Location: 930 STA1E ROUTE 149
Owner: DOLORES DOYLE LE
Applicant: DOLORES DOYLE LE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
,1,0
Director of Building& Code Enforcement
1
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010165 Application Number: A20010165
Tax Map No: 523400-051-000-0001-004-000-0000
Permission is hereby granted to: DOLORES DOYLE LE
For property located at: 930 STATE ROUTE 149
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: DOLORES DOYLE LE
930 STATE ROUTE 149 Septic Alteration Residential
LAKE GEORGE,NY 12845 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2001-165
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,April 17,2003
(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 Town nsb ues , pril 17,2001
SIGNED BY / (1r for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road QueensInny, NY 12804 (518) 761-8256
1. OWNER INFORMATION: •
Office Use
Location of installation: 73 d T—fe jp ,��Lt��-Z ftf
File Permit No:Q-01)1— /ijs
Tax Map No. / /
/•
Fee Paid • °
Owner's Name: /0 �. • 4 Ufa.e, U�.l-f
Address: '. ,50 </.J.e ; � 7�e j SC 9
2. INSTALLER'S NAME � n t,sl' r, �—,�— PHONE NO./ —376-1 DK
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(50 galgal/bdrm
1980— 1991 x 130 gal/bdrm = ` '
1991 —present x 110 gal/bdrm = 6 2 l
Apt
Garbage'Grinder Installed yes ODEEt�ISC l31���
Spa or Whirlpool Installed yes TOWN®F �D CODE
13UIL®1�G'�'
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
•
• To o=ra h Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
Mot— at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
%slope other from any septic-system
• depth: absorption is/ eff ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
••
Rate: 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 sire
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
•
Septic Tank: /Ode) gallon (min. size 1,000 gal)
• Tile Field: each trench • ft. Total System Length: ft.
Seepage Pit(s): number of size of each: _fl. by ft.
Size of Stone to be used: If_ / depth or thickness feet
Bed System Size: x
•
Alternative System: E7-3(' rJ length and/or size .52 0 X /v
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 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.
0 7 _
\Sighature lof responsible person Date
1 ' �U
101
TOWN OF QUEENSBURY
BUILDING &_.CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name aP)'? .bEi0ER) On`iL
Locatio 3C) R2 5 - 11AcA
Date Lk- ICI-DI Permit # —1657
SOIL TYPE: Sa��am-Clay- I
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: , •
ABSORPTION FIELD: Total Length /44►
Length of eachtrench C`� %P
Depth of trenches •3 ' I
Size of stone
SEEPAGE PITS: Number- . I.
Size - ft. x Vt.
Stone size \.
PIPING: Size Type
Bldg. to Tank. F-Nd� t �
Tank to. Dist—Box Lett►! - - ---
Dist. Box to Field/Pint QC lc, rIJE,J
Openings Sealed? es No Partial‘� mtm,
LOCATION/SEPARATIONS: \,
Foundation to Tank V feet
• Foundation to Absorption Nr3 feet
Separation of Pits \_ feet .
Conforms as per Plot Pl 4n \ es�No
LOCATION OF SYSTEM ON P°dOPE
(circle�• -
Front -1 ;► i eft Sig Right Side
Middle Front - /-ear
COMMENTS:
`\Ge ci he
//
•
SYSTEM USE APPRO YES 0'
Arridd" _L
De arts � ) �
l •/
uil nspector
-1.7777_____ ,, )...... r, ,.,
77,
. .
-±4} oF
r
\\
I J 41-4
5 i . Towp, 2001
I • . '
-, e",.
--------, ---- ..."-I211% p,
7 . .v"AAiD atiP -
--, u 9--
TBOUWILDNINur=:AP
REVIEWED BY ./. .ii• ' „AV
1
: t Al W/irri.
p(-::::ENS'•:UR Y
.....v • ..41,
e e '- - 4: PT 1,1
-751E 111
--__
. r -
0 0 d
1 have seen or observed, or believe I saw evidence of,
all Ants such as houses, wells, tree,s, le,nces, etc., 1-1-1 , 11
. t
shown on this document. I also represent that I have , ,-4
personally 11103Slired the distances set lorth on the diagr m." cJ
- .
(IGNATURE DATE 1
J
• v'd i
..v. .