2001-242 TOWN OF QUEENSBURY
Road, ueen b NY 12804-5902 (518) 761-8201
742 Bay Ro , Q s uty,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010242 Date Issued: Monday, May 07, 2001
This is to certify that work requested to be done as shown by Permit Number P20010242
has been completed.
Tax Map Number: 523400-295-014-0002-062-000-0000
Location: 62 MT. VIEW Ln
Owner: GERALDINE GILBERT
Applicant: GERALDINE GILBERT
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF UEENSBURY
11 41—
S'
Director of Building&Code Enforcement
/ 1, TOWN OF QUEENSBURY
VIEW-" 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010242 Application Number: A20010242
Tax Map No: 523400-082-000-0002-018-000-0000
Permission is hereby granted to: GERALDINE GILBERT
For property located at: 62 MT. VIEW Ln
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: GERALDINE GILBERT Septic Alteration Residential
62 MT. VIEW Ln Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
SIGNORELLI & SON
589 WEST MOUNTAIN ROAD
OUEENSBURY,NY
Plans &Specifications
2001-242
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday,May 04,2003
(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 o.- .nsb Friday a 04,2001
SIGNED BY a _ A for the Town of Queensbury.
Director of Building&Co e En cement
' Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
,�c� ` '' Office Use
Location of installation: IQP� /'G�d4✓/�%'��'<f'`� `' •giC
File Permit Nq l-01,1
Tax Map No. / / /
Fee Paid gs 62 L�l— `�'�
Owner's Name: r.E),e/q Z•dtiv e 61 z662/
Address: ( 3 A cixi%A/w/`i 'e:r) ZALt ,,�,, r ._
ri 1VEt
2. INSTALLER'S NAME : ���� J l tz.(4, 9(/ MAY 0 NE NO. lf=72-"
3. RESIDENCE INFORMATION: (circle year of dwelling, indi gedrooizi(s)�argdiltiply# of
bedrooms with applicable gallonspeA =tb Zcallzt.al daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older 3 6ll
x 150 gal/bdnn = 5 d
1980- 1991 x 130 gal/bdrm = O
1991 -present x 110 gal/bdrm =
l 1
\\-6Garbage Grinder Installed yes / no /w
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material omester Supply
Flat sand at what depth at what depth municipal
Rolling loam feet feet welf
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is 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 size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: //�z`9 gallon (min. size 1,000 gal) / A 2 1' (2 ''�"
-G`
Tile Field: each trench f. Total System Length: ft. e;0/�C 72)-
Seepage Pit(s): number of size of each: ft by f. f,/gcxJL'ra./ /"/` eJyt
Size of Stone to be used: # / depth or thickness feet '� t' L'ee T4 ��
ire �'ks/S
Bed System Size: x b V.
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 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.
V., 1 6/ 56 j —0 I
Signat re of r ponsible person Date
1/1111' 1 r"-)jp-
TOWN OF QUEENSBURY /x aO
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ( bey
Location C3 \-"\- V i eu_, Q
DateS — 0/ Permit # di =' -Z
SOIL TYPE: Sand-Loam-Clay-
Results of er olation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIE D: Total Length
Length of each tre 'ch
Depth of trenc s
Size of stone
SEEPAGE PITS: N.mbe, -
Size - ft x ft.
Stone size
PIPING: 111
Size Type
Bldg. to Tank it" 5z6 ACC
Tank to Dist. Box ,,L II
Dist. Box to Field/P. 11,
Openings Sealed? / - '' No Partial
LOCATION/SEPARATIOc,
Foundation to Tank ' feet
Foundation to Absorption . feet . .
Separation of Pits - feet
Conforms as per Plot Plan No
LOCATION . SYSTE ON PROPERTAO
j
(circle e
Front - e - eft ide - Right `•e
Middle Front �- id a Rear
COMMENTS:
PflA �C�-nLAVr/r4,�( NT- 0-v&5
SYSTEM USE APPROVED: YES NO
Arrived: , (7- 2'\)/)
Departed: '
V
Building Inspector
ii 0 u Ail A(vu U [ 1e `'`-) MILDIP3AY 03 2001
TOWN OF QUEENSBUPY
u AND
CODE
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TOWN OF QUEE ' SBURY
TO'ANOFQUEENSBURY WILDING DEPARTMENT BUILDING �c ��Ta
Based on our limited examination,
compliance with our comments shall REVIEWED BY
not be construed as indicating the
plans and specifications are in full DATE 5---
compliance with the code,