2001-711 TOWN OF QUEENSBURY
742 Ba Road ueensb NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010711 Date Issued: Wednesday, September 26, 2001
This is to certify that work requested to be done as shown by Permit Number P20010711
has been completed.
Tax Map Number: 523400-295-015-0001-031-000-0000
Location: 28 OWEN Ave
Owner: VALERE MORISSETTE
Applicant: VALERE MORISSETTE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(DJ —
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: P20010711 Application Number: A20010711
Tax Map No: 523400-295-015-0001-031-000-0000
Permission is hereby granted to: VALERE MORISSETTE
For property located at: 28 OWEN Ave
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: VALERE MORISSETTE Septic Alteration Residential
28 OWEN Ave Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans & Specifications
2001-711
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday, September 20,2002
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of eensbury before the expiration date.)
Dated at a To of Otipisbu j j, .:_lay, September 20,2001
SIGNED BY V for the Town of Queensbury.
Director of Building&Code Enforcement
�' Application for Permit—Septic Disposal System
Town of Queensbuty 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: c?"--P- V�1e_21
File P m i a Q/7#
Tax Map No. / /
ee Paid
Owner's Name: (// - (ZA H a n i „id e....�lE 2001
Address: ca—p
r „,,,,.....
sE ftTBUILDING AND CODE OF Y2. INSTALLER'S NAME : 9-/' /6z,..r �,,1 PHONE NO. 7901 '7'L`�'� 7
3. RESIDENCE INFORMATION: (circle ye of dwelling, indicate#bedrooms and multiply#
Y g, () P Y of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdnn = 6 0 0
1980—1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes O
Spa or Whirlpool Installed yes /40
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topora h So' ature. Ground Water Bedrock or Impervious Material Dotuesiic Water Supply
ring
sand) at what depth at what depth unicipa m 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 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: gallon(min. size 1,000 gal) 774"),--0,
Tile Field: each trench f✓0 ft. Total System Length:2 0 0 ft.
Seepage Pit(s): number of / /4' size of each: ft by ft.
•
Size of Stone to be used: # //i'�' / 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 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 rea egulations with respect to this application and agree to abide by these and all
require ents of Town of Queensbu nitary Sew e Disposal Ordinanc .
S gn ture of responsible person Date
L/= :')
r TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name i ' T-� $Mm'6C
Location .7-9 060&..-/ ,4,iC: _
Date l6 di Permit # 0( V//
SOIL TYP': Sand-Loam- . 'ay-
Results of Perco; ation Test-
(if applicable) 'ate-Minute/Inch_y
TYPE OF SYSTEM:
ABSORPTION FIELD Total L ng �7 -
Length of each t ench 1. 00
Depth of trenche•
Size of stone FIL.,—fa2A-�lz_
SEEPAGE PITS: Nu ber-
Size - ft. x ft.
Stone size 1
PIPING: - Size Type
Bldg. to Tank / G)L i J NC-'
Tank to Dist. -Boy; • �" 4aq:S
Dist. Box to Field/7- , • A4
Openings Sealed? 0Y-. No ,Partial
LOCATION/SEPARATION :
Foundation to Tank feet •
Foundation to .Absorp ,ion . _ feet . .
Separation of Pits • — ,eet
Conforms as per Plot Plan Ye No
LOCATION OF SYSTEM 0 PROPERT :
(.circle. ,
Front Rea, - Left' ide - Right Side
Middle E ont -- Mi ddl : Rear
COMMENTS: .
SYSTEM.USE APPROVED: YES NO
Arrived: /
Departed:
-1-ki—.)-3 eC.
. Building Inspector
"I have seen or observed, or believe 1 saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
n on this documer I also r resent that I have
1 pe wally measured sta set forth on th diagra ,"
' a , 9 /O of _
SIG URE DATE
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