2001-295 TOWN OF QUEENSBURY
742 Ba Road ueensbu Y 12804-5902 18 61-8201
��� v , Q rv,N (5 ) 7
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010295 Date Issued: Monday, May 21, 2001
This is to certify that work requested to be done as shown by Permit Number P20010295
has been completed.
Tax Map Number: 523400-069-000-0003-026-000-0000
Location: 2 WINCREST Dr
Owner: JOHN & MARY MROZINSKI
Applicant: JOHN & MARY MROZINSKI
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
j „I:,
Director of Building&Code Enforcement
•
TOWN OF QUEENSBURY
f -" 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
vtIR
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010295 Application Number: A20010295
Tax Map No: 523400-069-000-0003-026-000-0000
Permission is hereby granted to: JOHN &MARY MROZINSKI
For property located at: 2 WINCREST 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: JOHN&MARY MROZINSKI Septic Alteration Residential
2 WINCREST Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2001-295
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,May 21,2003
(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 ry; Mo a ,May 21,2001
SIGNED BY for the Town of Queensbury.
Director of Building&Code forcemeat
Application for Permit-Septic Disposal System .
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: p wy-ioc.rr,s J I File Permit No. �l q
5
Tax Map.No. / /
q- Fee Paid F2 0
Owner's Name: 1)�-.() ' i1 A) / /i fO?10 ,C / `��' d
Address: 1,,t J f(j r E-6--r— .
2. INSTALLER'S NAME Er__jig ic z v• Sat-J-9-v• PHONE NO. ( fd J VY
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily fl flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow °,--L-
1980 or older 3. x • 150 gal/bdrm = . 1/.5 d MAY 11 2001
•
1980— 1991 x 130 gal/bdrm = :INN'
O;�
1991 —present x 110 gal/bdrm = BLIII.l7r, �� �NBat1 Y
nlcs s,NO r,0pE
Garbage Grinder Installed yes / n
Spa or Whirlpool Installed yes /
•
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Toographv Soil Nature Ground Water Bedrock or Impervious Material Domgstic Water Supply
1,l sanJ a!what depth at what depth quigillarl
• - Rolling loam feet feet we I
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:A-17ml gallon (min. size 1,000 gal)
Tile Field: each trench 14D ft. Total System Length: C� ft.
Seepage Pit(s): number of size of each: • .f. by ft.
Size of Stone to be used: # / depth or thickness feet
• Bed System Size: x
Alternative System: / A t 1 lytt fc d. length and/or size 5- II fi f>
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.
. Ig, � -
Si n turiof responsible.person . Date
it 6°
TOWN OF QUEENSBURY
__BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,CY,6n '\Y'r,2:(41`
Location oZ W,` ncsns2/f V
Date /4-266)Permit gopo 1-045
SOIL TYPE:(San oam-Clay-
Results of Percola Test-
(if applicable) R e- 'nute/Inch
TYPE OF SYSTEM:
ABSORPTION. FIELD: Total Length ;.- 1 _
Length of each tre ch ;S�yn'
Depth of t ches ,- 3 r
Size of stone oAF1�-re -n'et7
SEEPAGE PITS: Num•-r-
Size - ft. ft.
Stone size
PIPING: Size Type
Bldg. to Tank _T_1►3-)TC)
Tank to Dist. Box ►C
Dist. Box to Field/P t t`. P\)L --t- 11C-441
Openings Sealed? es d.o Partial
LOCATION/SEPARATION :
Foundation to Tank ?-, feet
Foundation to Absorpt'on -rc feet .
Separation of Pits _ ` et
Conforms as per Plot elan Yes o
LOCATION OF SYSTEM ON PROPE
(circle on
Front- Rear, - ide Right Side
Middle Front "T a :ear
COMMENTS:
•
SYSTEM USE APPROVED: dallP NO
Arrived: :a
Depart
i ing Ins or
---- !\
.on, 3, 't tl
A- 'gu
X,,,,y , van
3.1V
`J
` - A8 4AM2IA J
4� Li; & owning.
'8)03 81a1 Lop 83Uend=
pi ui aye uogeoijpads pue sueid
eui Gug ,put se peruisl�o eq lou
pals spew wo me up.aouetidwoo
'uogeup x :; .. ino uo p3se
l
' 11 i 4
•
ff � ^7
I have seen or observed,or believe I saw evidence of, s
all objects such as houses,wells,trees,fences,.etc.,
shown on this document I also represent that-I have
personally measured the ' nces forth on the diagram."
N . k,t,.\--(79. ___ 's ,,_._. . . 67- /I— d(
, , IGNATURE . DATE
i • in
. /3-4-) • /
.
•
l
•
t
•
T AM