2001-572 41 '` TOWN OF QUEENSBURY
FON742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20.010572 Date Issued: Wednesday, August 01, 2001
This is to certify that work requested to be done as shown by Permit Number P20010572
has been completed.
Tax Map Number: 523400-279-017-0001-058-000-0000
Location: EAST Rd.
Owner: DAVID & JOANNE MYETTE
Applicant: DAVID &JOANNE MYETTE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
1-
Director of Building& Code Enforcement
�� TOWN OF QUEENSBURY
`a 1 742 Bay Road;Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010572 Application Number: A20010572
Tax Map No: 523400-279-017-0001-058-000-0000
Permission is hereby granted to: DAVID &JOANNE MYETTE
For property located at: EAST Rd
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: DAVID & JOANNE MYETTE Septic Alteration Residential
33 EAST Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency •
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY,NY
Plans &Specifications •
2001-572
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,July 27,2002
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Que-. bury before the expiration date.)
Dated at the Iwn of +1 ue bit; 'i I _,___-_-.y 27,2001
SIGNED BY J + for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Qiieel/sbruy 742IlayRoad Queensbuty, NY 12804 (.518) 761-8256
1. OWNER INFORMATION:
Location of installation:
e,..,...5 ei f ci 06 Office Use
Tax Map No. / /
Filo Permit No.� / S ` a.
Owner's Name: LCA. (} , d .e. TC,
Fee Paid - O v
Address: C 04-- 5 7 ( d ( `-.4i
2. INSTALLER'S NAME : J- , 0, S o le, %` PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate II bedroom(~) and multiply If of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Dail Flow
1980orolder 3 x 150 gal/bdrin = �S` ECEIVED
1980— 1991 x 130 gal/bdrni = JUL 2 u 2001
1991 —present x 110 gal/bdrm =
TOWN OF QUEENSBURY
Garbage Grinder Installed yes / no BUILDING AND CODE
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
_; ►ra h ` oil 1 ure _Ground Water Bedrock or Impervious Material _Domestic Water Supply
Mot (7/�v depth dep at w ra tlr n
lepua7icl/,al
/Jug ® /" feet
et GO
Steep slope clay well; water supply
__%slope other from any septic-system
•
• depth: absorption is/e)a.f.
other_
Percolation Tes : (To be Completed by licensed prnfi�ssional engineer or architect)Rate: t� 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: 7(900 gallon (min. size 1,000 gal) •
Tile Field: each trend __5
0—fl. Total System Length: 00 fl,
Seepage Pit(s): number of size of each: fl. by fl.
•
Size of Stone to be used: itD.,,.. / depth or thickness feet
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 that pursuant to Section 136-29 of the Code of the Town
of Queeusbury, 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 Queeusbury Sanitary Sewage Disposal Ordinance.
I.V
ter"_ 7 ‘—(7)06 I
ature of responsibr o ��Date
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,�tU i r-) M r
Location €G - .
'4 C..)
Date 7J Permit #O0( 701
SOIL TYPE: Sa' •''Loam-Clay-
\•
Results of 'erlcol ation Test-
(if applicable Rate\-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELt: To al Len t
Length of each t enc f. 50
Depth of trenche•
Size of stone
SEE AGE PITS: Nyber-
Size� x ft.
Stone size -
PIPING: i4e Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field P . 43
Openings Sealed? No . .Partiaal
LOCATION SEPARATIO S.
Foundation to Tank v feet
Foundation to Abso ption . _ ,f, feet . .
Separation of -Pits -et
Conforms as per Plot Plan o
LOCATION OF SYSTEM ON PROPERT
(circle limo
Front - '`i�i1r- Lef Side - Right Side
Middle Fr.- . - Middle Rear
COMMENTS:
�.4 (o - b(L
SYSTEM.USE APPROVED: • NO
Arrived:r
Departed: � •
. Building Inspector
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