2002-643 t
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: P20020643 Date Issued: Wednesday,August 07,2002
This is to certify that work requested to be done as shown by Permit Number P20020643
has been completed.
Tax Map Number: 523400.309.007.0002.046-000-0000
Location: 10 NATHAN St
Owner: ARTHUR&JULIA COON
Applicant: ARTHUR&JULIA COON
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
r
Director of Building&Code Enforcement
ETOWN OF QUEENSBURY F '� L
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P26020643 Application Number: A20020643
Tax Map No: 523400-309-007-0002-046-000-0000
Permission is hereby granted to: ARTHUR & JT)T,TA COON
For property located at: 10 NATHAN St
it,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: ARTHUR&JULIA COON Septic Alteration Residential
10 NATHAN St Total Value
QUEENSBURY,NY, 12804
Contractor or Builder's Name Address Electrical Inspection Agency
Plans&Specifications
2002-643
Septic alteration per plot plan and specifications.
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 01,2003
(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
ust 01,2002
ugul -
SIGNED BY lT, urs
t—for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bav Rocid Queensbury,NY I2804 (SIS) 7G1-8256 ���,03
1. OWNER INFORMATION: _ - _
• . `- -E �11 � � �C Use �- #
Location of installation: f t2 / l k 4 it 5 Fi1e"Per�ni�1��0 �
Tax Map No. / / Tol
Owner s Name: (/
Address: ZZ2 n tom. f' ..jog,7
2. INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s)and multiply#'of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: Na of Bedrooms x Commutation — Total Daily Flaw
1980 or older x 150.gallbdrm =
1980—199L x 130 gal/bdrm = O
1991 —present x 110 gallbdrm
Garbage Grinder Installed yes_ /
Spa or Whirlpool Installed yes_ /
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Too h Soil Nature Ground Water Bedrock or ervious Material Domestic Water Su 1
at what depth at what depth muni
Rolling Loam feet feet. well
Steep slope clay tfwell;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 it 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 Tanls;/�o-zr c) gallon(min.size 1,000 gal.)
--mile Field: each trenches ft Total System Length:
Seepage Pit(s): number of size df each: fl by fl
Size of Stone to be used: # % depth or thickness feet
Bed System Size: x
Alternative System: length andlor size
6. HOLDING TANK SYSTEM: (if required)
Number oftanks: - / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated,electricai 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 ofthe 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.
Z_ � 7 �
Si�srer�esponsible person Date
TOWN OF QUEEKSBURY
BUILDING &--CODE ENVORCEMEN-IF
742 Be-x_y Rc)kc-jcj
Quiet--n L-.t3pu ry MY 32SO4
SEPTIC DISPOSAL SYSTEM INSPEC-rIOM
Name
Loca *tlon �
D at e __7 ,�-7 Permit #
oam
SOIL -TYPE: %and) -ClayofResul -ts o Pe- 1-cala-tion Tes-t-
( i _F appl ! cable ) Rate--Minute/Inch
-TYPE OF SYSTEM=
ABSORPTION FIEILD : Total Len -th
Length of each -ti-ench
Depth of trenches __ZI I
Size- of stone
SEEPAGE PIT-S : Number-
s I Z -Ft- x -F-t
S -ton,e_ size
PIPING : Size Type
Bldg . -to, Tank
Tank- to Dist _ Box
Dist . Box -to Field/Pj
Openings Se__aI -r_--d ?_ e
o Par--tial
I-OCAT-I[Otq,/SEPARA-r
Founda-tion -to Ta-n - -feet
Founda -tion -to Absorption LL=- -feet
Sepa,rat-ion o-F Pi iset
Conforms as per Plo-t Plan 0
LOCATION OF SYSTEM on pROpE
( ci Y-cl f--- one )
Fr-ont - Rear- - L Side - Ri h-t Side
Middle Front - iddle Rear
R-1 c I _g S _V Lnddl:i�e; :FRZ
SYSTEM USE APPROVED = YES RO
Ar-r--f t--cf=
D&-_p it
R
JUL 3 O ZOOZ
®W
a
O ,
& Ec
W N !~J7 , 27
TO
,
BUILDING & O
REVIEWED By
MATE .�..--------"
"1 have seen or observed, or ¢
obier s�rch as f;c�usa J�believe I save evidence of,
s, Wells, ,sees, fences, etc.,
shtt;�irrt Misr ciir. a�
�, t. ; a;;o rep resent that I have
.s s'r�ally ,7iea, reG t,:Y distances set fort h o the diagram.,,
Si NATURE
GATE