2002-731 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CEIRAT IFICa' T E
OF COMPLIANCE
Permit Number: P20020731 Date Issued: Tuesday,November 19,2002
This is to certify that work requested to be done as shown by Permit Number P20020731
has been completed.
Tax,Map Number: 523400-296-014-0001-007-000-0000
Location: 78 MONTRAY Rd
Owner: GRAYSON PROPERTIES LLC
Applicant: GRAYSON PROPERTIES LLC
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: P20020731 Application Number: A20020731
Tax Map No: 523400-296-014-0001-007-000-0000
Permission is hereby granted to: CYRAYS6N PROPERTIES LLC
For property located at: MONTRAY 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. T"e of Construction Value
Owner Address: GRAYSON PROPERTIES LLC Septic AlterationI Residential
1004 CHESTNUT St Total Value
MECHANICVILLE,NY 12118
Contractor or Builder's Name/Address Electrical Inspection Agency
JBS SEPTIC
IVAN BELL
2 LOWER WARRFN STREFT
OTJEENSBURY.NEW YORK
Plans&Specifications
2002-731
Residential septic alteration per plot plan and specifications.
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 28,2003
(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 T6 Wof4 4t"dny,August 28,2002
I
I F
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit-Septic Disposal! System
Town of QueenSbUry 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1 OWNER INFORMATION:
Ply.. ...........................................-.....0-............Mice..Us-e..............................
Location of installation: 9/1-,e)..%,/`/1CC- iV.&JA -
Tax Ma t File Permit No. 2-n-d 2�--7 37
p No. "4
3a Paid
Owner's Name: r-C, L- /7 A-
...............I....................... ......................................................... .......
Address: RECOVED
2. INSTALLER!S NAME PHowEN&.UF, 2 8 2002
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) andRaffiplk M6f-ENSBURY
bedrooms with applicable gallons per bedroom to equal toR7'AMi,7jV7— ?_iIODE
Year of House: --.Ho-. of Bedroo
ms x computation = TMI Daily Flow
1980 or older x '. 150 gal/bdrxn =
1980- 1991 x 130 gal/bdrm =
1991 -present x 110gal/bdrm =
Garbage Grinder Installed yes no,
Spa or Whirlpool Installed yes_ J no
4:- PARCEL INFORMATION: (circle applicable information&indicate measurements)
IMM Soil!%'Pature Ground Water Bedrock or Inipervious Material ter Surmly
F7a-t,-' (sand,--"— at what depth a ha epth municipalY
r 11
'-RO-Zling t :V/ feet
Steep slope clay tf well;water supply
slope other from any septic-system
depth: absorption is ft
other
Percolation Test: (Fo 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 eagh Garbage Grinder,'Spa or Whirlpool Tub.
Septic Tank: &6—o gallon(.,.. ,Yjzel,000'gal.)
Tile Field: each trench
_ft. Total System Length: ft,
Seepage Pit(s): number of _a size of each: ft- by
Size of Stone to be used: # f depth or thickness ✓ feet
Bed System Size: x
Alternative System: length andlor size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: l 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 purs
uant to Section 13 6-29 ofthe Code of the Town
of Queensbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentatioft 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.
"St'griature of r�esporiislbte—person Date
'a
. . . � • •1'otvtt t>f tlttcr.�►al:ui•y .
S(!%Vers :iit(t sew.ilpt! Di:epos.il t:i�:sj:tc•e
Avi)(mdix t
A13.t-itJltI""ION PII;IAJ
.�iI�.I'/�1tA'I'IC}N it:I��tt[.?i1tIrF�II�:N'I';;
•�.�: \-p1�/ .ter%
1 .-3 lrlB a t_ ut tip�F rt_ -r f"r J r_t Wilt-)
1><yur C15,.Ic; �` ...
t 't
G p '
t ScI,t1c,
r.:t.r
PON 1)
EJ,-.,tt„mot j,t..t,
- rznno r _ _ ._ ---------Y--""_-
7. SIGNATURE &INFORMATION FOR FLhSl vr4bx0J1 r,r>Jaavi� v��•••••.•.�
w
4- 4- 4- or. C?
a v 4-)
c ,; of C
CL v 0
W
MO�7 M � � -P (0 �-= c '� 0 C 1 (U
V
ki c (01% a) 0
't 00 U 0 �
W ) v E or- 0 U v x cn v
pW a (04J � , �-
0 roro " vLX s. 0 4Jb G
O N ' °� 0 0 41 0 Z 4- 0 v(-$ � ro �,r 9 Cr1
It, cl C �. 0 W.CU LLOm v » 1 �r
�f �" 0. A U. 0 a) �� I r. 0 0 4- av) 'C
N cz �to Iv� S. Q� r
N 0x \ 000 00. S. �� W CO
U Cw r4 M O `r r r r il, R/J W
0 0 0'�1 '" 04-W N �� 4' 0M b)l � +) � �
{ N - W' r• acCL -C 00 1 U 4J CW ro,ro Mw ! 0z 'C
W v ro v a WCrnv0. v0H �.k +' 1~� � 0ro' s» 0 irro
E U +j M N4-Off 0CCLNWN0IVC0vU � � �1. C�tr0 .0 0 r� 0 �U.r� m v a1 'rW -r- 4J roar QC: 0 0 0 00 U S� •ra
MY' U 2002
1'O��rt�l
P`9 CODE
"I have seen or observed, or believe I'saw evidence of,
all objects ;uch as houses, wells; trees; fences, etc.,
shown on this document, I also re �resunt that ; have
personally nneasured t1he distances-set.forth on the diagram."
�Jv0
: . SIG ArURE DATE- ;
or
TOWN r to RY
BUILDING-
REVIEWED BY
DATE
r � .
'r (D Q) O 0
+� 0) 0) 0) It- 1 0
d �+ 4J
N t `, N P Z
4J ro r. '
1 0 1 +J Z S. 'r y" 7}*y "y
w �' V J
i �+ y, 0 E 'r aD 0 U 0 x 4 a �0 a1 ►� C
0 ro 0 „ (D (AE ':3 4J M o th rw 1 4, w
14 ,f r i "" $��N C �» 0 z w U LL W GG 4}�" I I
t ro Q1 r-W W Co .. � � r-d 0 0 4- IZ� � a
0 L tT�, �
A. .0 L CV) C4J 0 roa +� 0 •• � +) .� d to
0z p roV) vs- h roln N . 41roC y 0
h 4- U -P id 0 F- '� V) CCCroC Caro w
Q 0 'r V) 4- a �, 0 00 0 zC r M 04. 'r 0 N +r'r'r• to U, t1� z �►
M 0 N IwLu. h 0 4-W N t7'�f '1) P -W
' Cx,C a •C 0 0 0 � c4.ro � � r Q!z `� � �►
a1 +� r� tq C1C Q)z ' . 'r"�'" `0 �. 0� U � WCIO W � �
W Q) ro v W. 2 W C 0)4J 0 C. 0 C H 1).� +) C d C ro 4-d C a eP. M
VI E U -P H (A4-aV) C QNW N 4CL '0 C 0 OU Z :5 aCU 'r 0 �7
rti 0 'r- >- m Q1 Qt'r•W'r- P Or 40 0 0 Q3 00 U � 'r C y'