2001-732 TOWN OF QUEENSBURY
742 Bay Road, ueensb NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010732 Date Issued: Monday, October 01, 2001
This is to certify that work requested to be done as shown by Permit Number P20010732
has been completed.
Tax Map Number: 523400-296-017-0001-024-000-0000
Location: 19 CARLTON Dr
Owner: GEORGE &BARBARA BEYERBACH
Applicant: GEORGE &BARBARA BEYERBACH
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
7f „4,
Director of Building&Code Enforcement
_ - TOWN OF QUEENSBURY
-,
` 1-1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010732 Application Number: A20010732
Tax Map No: 523400-296-017-0001-024-000-0000
Permission is hereby granted to: GEORGE& BARBARA BEYERBACH
For property located at: 19 CARLTON 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: GEORGE&BARBARA BEYERBAC Septic Alteration Residential
19 CARLTON Dr 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
2001-732
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Tuesday, October 01,2002
(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 Quee bury; Monday, October 01,2001
SIGNED BY cl /,o, for the Town of Queensbury.
Director of Buildin &C e Enforcement
Application for Permit—Septic Disposal System .
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
l 9 t�� r C(Q'� C orree Use
Location of installation: 7L--' t^,i� '7
File Permit No /—
Tax Map No. / / 7�3
/
,' Fee Paid c 5
Owner's Name: 6-('4 tr.,c /1 S e c r-g�C•Gt
Li
Address: 7 /� / '/','
•
2. INSTALLER'S NAME : I2T ' /)L c-,_ cC 1, ( PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate #bedroom(s) and multiply fig .. -•
bedrooms with applicable gallons per bedroom to equal total daily t � �
Year of House: No. of Bedrooms x Computation . = Total Daily Flow S ) 2 7 2001
SE)
1980 or older 3 x 150 gal/bdrm = Y TOWN OF QUEENSBURY
1980— I991 ) � T 41O ND CODE
•
x 130 gal/bdrm = LAUI'L.DING AN...
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes / no t �,
Spa or Whirlpool Installed yes / no h •
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
T:.s !raphy S. ature Ground Water Bedrock or Impervious Material in stic ter Supply
at what depth at h t depth nunicipel
Ro ling oam _ eet feet well
Steep slope clay if well• water supply
__%slope other froth 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:/60O gallon (win. size 1,000 gal.)
• SO /
�O r^� G l/�/U /`
Tile Field: each trend jes ft. Total System Length: ft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: it / 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 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.
V _ (7)_ 74 eor
•
Signature of responsible person Date
\
TOWN OF QUEENSBURY
BUILDING. &_CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �--�; Prc7-)E4EaRqcv.k
Location _ 1 cA C,4ARL0 ()Q
Date ci— 28._0( Permit #Zt3Z�
SOIL TYPE ' p,. oam-C1 ay-
Results of P:.rco .tion Test-
(if applicab e) Rite-Minute/Inch
TYPE OF SYST
ABSORPTION FI:LD: Total Length .
Length of each tr:nch
Depth of trencies
Size of stone
• SEEPAGE PITS: mber-
Size - 7. x ft.
Stone size
PIPING: Size Type
Bldg, to
Tank to Dist. Bo • Pl" ,t"'o Q -1yr
Dist. Box to Fi e1 d/Pit'- ) ' � , .To `1;:*' �-.
Openings Sealed? qe� No Partial
LOCATION/SEPARAT 0 S. �,� �
Foundation to Tan' �� 16cefeet
Foundation to Absirption !iG Jrfeet -
Separation of Pi s _ feet
Conforms as per 'lot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear`-._.Left....Si�de - Right Side
Middle Frost" - Middle Rears.
COMMENTS:
f
SYSTEM! USE APPROVED: ]
Arrived- I) '- ,,ter
Depart : y
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■ 0 _ i hav_e_seen_or observed,,or-believe-i-saw�evidence of,
■7 all objects such as houses,l--wells,_trees,l fences,etc.,IJ shown on this document t also re present that_I have I
-personal( 1 ' asured the di races set forth on[the ldiagram"
Iii. . ... ■ LiIGNATU . — DATE
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