2001-365 joisk
400_01 TOWN OF QUEENSBURY
Fos 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010365 Date Issued: Wednesday, June 13, 2001
This is to certify that work requested to be done as shown by Permit Number - P20010365
has been completed.
Tax Map Number: 523400-066-000-0004-004-003-0000
Location: 8 ORCHARD Dr
Owner: JOHN &MARION CUSHING
Applicant: JOHN &MARION CUSHING
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: P20010365 Application Number: A20010365
Tax Map No: 523400-066-000-0004-004-003-0000
Permission is hereby granted to: JOHN&MARION CUSHING
For property located at: 8 ORCHARD 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&MARION CUSHING
8 ORCHARD Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2001-365
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,June 05,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To of een ' ifdrche 05,2001
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queenshury 742.Bay Road Queensbury,'NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Location of installation: .lPG• cf_ co (. I
Office Usc
File Permit No.
O l_ 5
Tax Map No. / / Cy0
Owner's Name: ai c f� ['✓c �
Fee Paid`
Address: . Vr
2. INSTALLER'S NAME.: -{� PHONE NO� q aa
1� P �i..7�
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroon(.$)and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooitis x Computatibn = Total Daily Flow
1980 or older x 150 gal/bdrm =
x 130 gal/bdrm = 7 "I:
1991 —present x 110 gal/bdrmGarbage Grinder Installed yes noJUN 0 4 2 ]
Spa or Whirlpool Installed ' yes— / TOWNQt'0fSUf i BUILD ��T 0
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
>raphv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
at what depth at what depth fIrSECIA
Rolling own feet , • feet well
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 niust 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: (p o G gallon (min. size 1,000 gal)
Tile Field: each trend . _fj'C)ft. Total System Length: ZOO it
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # . �/ depth or thickness /' feet
Bed System Size: x
•
Alternative System:C;.
Y frl 'f -ek,fe.a`-S length and/or size02„ a-t,
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
j 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.
k.„,p,< J(71 E 17-- a
Shur--of responsible person Date
: ;,; t TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12864
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (::Al k\
Location 0 ORCA-0- ) Q.
Date \C-3j
0 f rmi t # 01.---'0��f
SOIL TYPE: and-Loam- lay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch ,
TYPE OF SYSTEM:
ABSORPTION FIELD: To . :ngth/ QV
Length of each tren v-
Depth of trenches f,
Size of stone 11211 ,C,/-: I `-
SEEPAGE PITS: Numb:r-
Size - ft. • ft.
Stone size _
PIPING: Size Typ
Bldg. to Tank Cr: i/ __ -y
Tank to Dist. Box n
Dist. Box to Field/' i . It q
Openings Sealed? 421, No . Partial
LOCATION/SEPARATION. :
Foundation to Tank. _4;/. feet
Foundation to Absorption feet
Separation of Pits __ feet
Conforms as per Pot Plan Yes No
LOCATION .1 SYSTEM ON PROPER .
(circl ' one\
Front Rear - Left Side - Right Side
Middle - Middle Rear
COMMENTS: .
•
SYSTEM.USE APPROVED: YE NO
Arrived: ji__4_<
Departed:
-__\F-e7
Building Inspector
I
_ "I have seen or observed,or believe I.saw evidence of,
all objects such as houses, alsolsrepresent that,l have I
shown on this document.
personally measured the distances set forth on the diagram."
'.L.-. —L-2_1,_ —
1GNA RE DATE
310t—
.
E aD
JUN 0 4 2001
TOWN OF QUEENBBUR`l .
BUILDING AND CODE
e-7
..y . --- _ : o_t, ....._
6
—�a r f -
v
' ±- li
S.
s
t . 0
,, T •
c ,
, .6, „ ----9 c) '''' '--- f
. TOWN OF QUE--...4 : P Y
BUILDING Atji ' EPT.
REVIEWED BY.
_._ i . :__
,.,I,, .,,I i
.._ �_..�• .fir/....
r
c P kr R' P° -y--f,--t t L K. (_,