2001-325 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: P20010325 Date Issued: Wednesday, May 30, 2001
This is to certify that work requested to be done as shown by Permit Number P20010325
has been completed.
Tax Map Number: 523400-091-000-0003-004-000-0000
Location: 3 PROSPECT Dr
Owner: BRIAN& NANCY LA FLUKE
Applicant: BRIAN &NANCY LA FLUKE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
ll #ite-
Dvector of Building&Code Enforcement
TOWN OF QUEENSBURY
i 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010325 Application Number: A20010325
Tax Map No: 523400-091-000-0003-004-000-0000
Permission is hereby granted to: BRIAN &NANCY LA FLURE
For property located at: 3 PROSPECT 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: BRIAN&NANCY LA FLURE
3 PROSPECT Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans & Specifications
2001-325
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,May 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 To ueens ryueens ry; Tb y, May 24,2001y, May 24,2001
SIGNED BY for the Town of Queensbury.
Director of Building& .ode nforcement
`��`` Application for Permit—Septic Disposal System
.l onVll of Qiiceii sl1111 y 7.12 Bay load Queensbnr;, NY 1280.1 (.518) 761-8 256
1, OWNER INFORMATION:
6 R. Office Use Location of installation: r �'
r�c� .C i )�',�
Tax Map No. / / Kilo i'oimit Nd�4'JV�-301
Owner's Name: l V G-n-- .,U,r Tree Paid ors DD
Address: r D 0 i-- a
2. INSTALLER'S NAME : - . - I.- L PHONE NO.ZU_____2 d' s 7
3, RESIDENCE INFORMATION: (circleyec r of dwelling, indicate li bedroom(%) and multiply II o/•
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House; No. ()Bedrooms x Couipulatiou - Total Daily Flow
1980 or older J x 150 gal/bdrti( = %S"o
1980— 1991 x 130 gal/bdrnt =
' 1991 —present x I lUgal/bdr'I =
Garbage Grinder Installed yes no
MAY 2' 2001
Spa or Whirlpool Installed yes 2
TOWN OF OUEENSBURY
4. • PARCEL INFORMATION: (circle applicable information & indicate lneasurenients) t3VI. 2ltV% 'wND CODE„____
111 S '—_ MO Ct_cund Water Bedrock or lil,hclvious Material �r►:^""-�
aim= scan! al what depth (II IOW(dc'/,lir .fll ills. �lcr bnitl?�y
a llf; a lien fe'CI well
Sleep slope clay If well; ,valet supply
slope other
• depth: from any sync-spiel,:
absoi ption is fl.
• Other •
Percolation Test: (l o.be cbmplelecl by licensed professional engineer or architect) ---
Rate: minute per Inch
5, PROPOSED SYSTEM: Fur New Censtniclion: All individual sewage disposal systems 'mist be designed by a licensed
professional engineer or architect(unless installed in a Planning 13oard annuved subdivision), Add 250 gallons to the size
• of the septic lank and leach field for each Garbage Grinder, Spa or WhitIpool Tub.
I EV c('.T/AJ&Septic Tank: / L �� gallon (milt. size 1,000 gal)
Tile Field: each irenc/s CD fl. Total System Length:` ,,,g ?)O /1.
Seepage Pit(s): number of liter/ ' size ()teach: 11. by f1,
' Size of Stone to be used: II ,/1-)/A" / depth or thickness- _________fret
et
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 note(hat 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 Misrepreserrl.aliol' or Whirr)to make a material (bet or
circumstance known by or on behalf of nn applicant, shall be void.
. I hay end the illations with respect to this application and agree Io abide by these and nil
requi•oruouts of th Town of Quccn ur Sanitary Sewage Disposal Ordinance,
1
gt ture of responsible person Date
.... TOW OF I ii
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date r-� 10 Permit NC) 3aC)
SOIL TYPE: III
Loam-Clay-
Results of Pe-colation Test-
(if applicable) -Minute/Inch
TYPE OF SYSTEM: i
,q
ABSORPTION FIELD Total Leng !th / z
Length of each tench 1 ";2
Depth of trenche 2
Size of stone NF( c
SEEPAGE PITS: Number-
Size - fu. x ft.
Stone size
PIPING:
Bldg. to Tank 1a-5�Nce
Tank to Dist. Box t 11-'9' S.yt 15
Dist. Box to Field r ,
Openings Sealed? `o Partial
LOCATION/SEPARATION,
Foundation to Tank feet
Foundation to Absorpti 'n ,ia feet
Separation of Pits rillifleet
Conforms as per Plot Plan No
LOCATI TEM ON "OPER
(circl
Front - Rear Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YE NO
Arrived: riv
Departed:Building Inspector)�1'
z! 0 _ ir ;, rrc) -
1
l
a ,9-00I ' -
o RECEIVED
MAY 2 2 2001
TOWN OF CJEENSBURY
'..-1,-)
f�A6 BUIIDINGAND CODE
V
1 i
a� C. 'J f'; h >
I
,
i
TO'WNOFLUEF; T?JnY0U!'LDrrd6 OE;vBTMENT l
Based on ur linked examination,
compliance with our comments shall
"I have seen or observed, or believe I saw evidence of, not be construed as indicating the
ail ohrvcrs such as houses, wells, trees, fences, etc.. plans andspecifcatrons are rn full
sorm_' , t;c 'ant I also represent that I havecompliance with the code
( y ,tsta is set forth on the diagram"
r asd d9_ . '
�� /
SIGNATURE DA TOWN OF QUEENSBURY
BUILDING ri& ¢( T
REVIEWED BY`� .
DATE Z /