2001-274 TOWN OF QUEENSBURY
742 Ba Road ueensbu NY 12804-5902 518 761-8201
l Y ,Q rY, � )
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010274 Date Issued: Monday, May 14, 2001
This is to certify that work requested to be done as shown by Permit Number P20010274
has been completed.
Tax Map Number: 523400=302-005-0001-046-000-0000
Location: 17 CARLTON Dr
Owner: ROBERT &PATRICIA BARBER
Applicant: ROBERT &PATRICIA BARBER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
4
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: P20010274 Application Number: A20010274
Tax Map No: 523400-072-000-0003-027-000-0000
Permission is hereby granted to: ROBERT&PATRICIA BARBER
For property located at: 17 CARLTON 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: ROBERT&PATRICIA BARBER Septic Alteration Residential
17 CARLTON Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans &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 of Que nsbury; onday,May 14,2001
SIGNED BY �fJ // '
� r� for the Town of Queensbury.
V r/
Director of Buil•trg&to de Enforcement
Application for Permit—Septic Disposal System
•
Town of Queensbury 742BayRoad Queensbury,NY 12804 (518) 761-8256
• I. OWNER INFORMATION:
Location of installation: ` C r. �,to ti d P. vC Office Me
Tax Map No. / / File Pennit No
1-a--7
Owner's Name:17 I.?0 6r rl or. r' ‘c t^ Fee Paid
Address:
iGt Lrdti dr ,'k •
2. • INSTALLER'S NAME : .a, S. sr ) ,>;-� PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling,.indicate II bedroom(s) and multiply it 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 3 x ' 150 gal/bdrm = Q,S a
1980— 199 • x 130 ga1/bdrm = r--, ,-
.1991 —present x 110.gal/bdrin _ • t, tV
Garbage Grinder Installed . yes / no MAY 11 200�
. Spa or Whirlpool.Installed yes / 'no k .. . • TOWN OF c UE ?`1SBURV
•
BUILDING AtJiC367
4, PARCEL INFORMATION: (circle applicable information & indicate measurements) V
tSl_t9 _ Orou!rd Watgr..D44rock__orJ_tmporious Motcrlii • . R.x,• Wator_Supply
l'7a sand at w! 'QT feet fle !' •
al w/iaj iepil, ►ve"icipt
oilingn . ` feetSteep slope clay. if well; water supply
%slope other from any septic-system •
depth: absorption is fl.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rale, minute per inch .
5, PROPOSED SYSTEM: For New Construction: All individual sewage,disposal systems must be designed by n licensed
professional engineer 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: / a a ga4on (min. size 1,000 gal.) .
Tile Field: each trench 44) "fl. Total System Length: O O f. /r✓1 i tC( '' ''
Seepage Pit(s): number of size of each: . ft. by fl.
Size of Stone to be used: ll -/ depth or thickness.____._._____•/i'ct
•
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.
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•
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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 those and all
- . requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
•
cAl6 S 9---ccd
nature of responsible Person Date
WM
TOWN OF QUEENSBURY
) 'I30
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name R0rA Q--lae -)Q,,/
Location � � < ' li e
Date 5-9'0-00/Permit # 0/ --24
SOIL TYPE: Sand Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: 1 F
ABSO" ON FIELD: Total Leith
Length o- each trench ( ,�V
Depth of trenches 3
Size of stone um F7-4/C _ Ups
SEEPAG: PI umber-
Size - ft. x ft.
Stone siz-
PIPING: Size Type
Bldg. to Ta
Tank to Dist. Box y-" 5pre. 35."-
Dist. Box to Feld/'i 14 I
Openings Sealed. �'- No . Partial
LOCATIONi/SEPARAT N,
Foundation to Tank 52--feet
Foundation to Absor.tion feet . .
Separation of Pits feet
Conforms as per Plot ' an es No
LOCATION OF SY TEM ON ' 'OPERT :
(circle
Front Rear IMNOR ide - Right Side
Middle • - i .dl a Rea
COMMENTS:
SYSTEM USE APPROVED: YE NO
Arrived:_
Departed.
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name \\CPri-\
Location /7 C r*i2L-tow 0- J- /
II
Date V27/ / Permit # Pa'oprG
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank. feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS: tZrc.
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: t ( C)
Building Inspector
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_I II halve seen or observed; or believe I saw evildenfe of, i
a �II objects stitch as houses, wells,[trees, fences, etc.,
I shown oij-this do-current. I-also-represent tha#-I-have-
','� — personally m aseJred=the 1distanc s_set for.th oln_t�ie dia ram.
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