2001-276 01110.
TOWN OF QUEENSBURY
Foo 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010276 Date Issued: Monday, May 14, 2001
This is to certify that work requested to be done as shown by Permit Number P20010276
has been completed.
Tax Map Number: 523400-090-000-0004-090-000-0000
Location: 27 HELEN Dr
Owner: EARL & LINDA LUCCI
Applicant: EARL & LINDA LUCCI
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: P20010276 Application Number: A20010276
Tax Map No: 523400-090-000-0004-090-000-0000
Permission is hereby granted to: EARL &LINDA LUCCI
For property located at: 27 HELEN 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. Type of Construction Value
Owner Address: EARL &LINDA LUCCI Septic Alteration Residential
27 HELEN Dr Total Value
QUEENSBURY,N.Y. 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2001-276
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,May 14,2003
(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 ueensb ; Mond y,May 14,2001
SIGNED BY for the Town of Queensbury.
Director of Building& de orcement
Application for 1'crulit—Septic Disposal System '
Town of Queens-billy 7.12 Boy Rloaid QueeusInny, Ni' 1280,1 (518) 761-8256
1, OWNER INFORMATION:
"� _ `V" �`'� �"J 'B Office Use
Location of?installation: / IT L.Q� b
Tax Map No. / / I• ntimit NO'- ~). -
-a- co
TOWN OF O JP tiiMi ii4 '�D v—
Owner s Name: / fti JL Lild-c.-c BUIL®ING ANi.) �.E ,
/''
Address: - 2 i'T -e,,L- .e A./ D2- ,
2. INSTALLER'S NAME : AN L,-f� r,,..._.. PRONE — 7 ` f
3. RESIDENCE INFORMATION; (circlo yearof dwelling, indicate !1 bedroom(s) and Multiply!! v/'
bedrooms with applicable gallons per bedroom to equal lvlal drily flow)
Year oft-louse; No, of Bedrooms x computation - _Total Daily Flow
1980 or older4- x 150 gal/burnt = 6-7) •
1980— 1991
x 130 gal/btlrl►t
1991 —prescllt x I lU gal/bdrut =
Garbage Grinder Installed .yes / iio
Spa or Whirlpool Installed yes_� / no D
4. . PARCEL INFORMATION: (circle applicable information & indicate measurements)
T 'ta I ktt Oro CmwtdWater Bedrocicyr linnet vious Matctial 1
roc art what depth at Om/depth Valet Supply.
a /lig loomst e ,rrnicl ,
fi
Steep slope clay — ffeet a e
if well; water.supply slope other
• depth: from any septic-,system
•
absolptivn is Jl.
other
Percolation'Post: (1 o_be completed by licensed pre fi�ssivnal engineer or architect) _ ____—
•
Rate, minute per Inch
5, PROPOSED SYSTEM: For New Construction: All individual sewage disposal syslcn►s must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board annovcd subdivision), Add 25(1 gallons to the size of the septic lank and leach field for each Garbage Grinder, Spa or Whit(pool Tub.
' Septic Tank: MOD gallon (min. size 1,090 gal)
Tile Fiold: each trench , ?A- ft. Total System Length:— A.
Seepage Fit(s): number of �- size of each: /O fi, by 7 fl.
Size of Stone to be used: ii 3 — / depth or thickness_ 7----.. __pet
13ed 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 note that pursuant to Section 136-29 of the Code of the'Town
of Quecn'sbury, any permit or approval granted which is based upon or is granted in
reliance upon any material mistepresentation or 1'srilure to make a material Ihct or
circumstance known by or on behalf of an applicant, shall be void.
I have road the regulations with ;aspect to this application and agieo to abide by these and all
roquiroru• •fthe Town of Qucensbuty Sanitary Sewage Disposal Ordinance.
a'/ r ektAAji(1,4
‘'Llos (
El•nature of responsible person n Date
2/220 -/04,<
TOWN OF QUEENSBURY jm
m i DING &_CODE ENFORCEMENT
742 Bay Road
,.= Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
/
Name 6(
Location
Date (' r Permit # )6 -0.77(4?
SOIL ` P'. Sand Loam-Clay-
Results of Percolation Te:t-
(if applicable) Rate-Min ,te/ nch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches ma
Size of stone
SEEPAGE PISS: Number ow
-
Size - Ge ft. Mr ft.
Stone size � r
PIPING: P7 Size Type
Bldg. . to Tank
Tank to Dist. Box `�/c1fL�v`J
Dist. Box to Field/Pi
Openings Sealed? Ailip No Partial
LOCATION/SEPARATION
Foundation to Tank feet
Foundation to Absorpt'on } feet
Separation of Pits — feet
Conforms as per Plot Plan Agmh No
LOCA ON OF SYSTEM ON PROPER Tar
r 1 - one)
ont. Rear - Left Side - Right Side
is e Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: 0":-S5
e/
Building Inspect r
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e "I hve see . . nce of,
-2 ® all objects such as houses, wells,trees,fences, etc.,
c shown on this document. I also represent that I have
Pi +, ly measured t " Lances s rth on the iam .12
,.y. - SIGN E DAT