2001-816 T
.04 . TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
��� Q �y
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010816 Date Issued: Tuesday, November 26, 2002
This is to certify that work requested to be done as shown by Permit Number P20010816
has been completed.
Tax Map Number: 523400-296-013-0001-073-000-0000
Location: 73 MONTRAY Rd
Owner: GRAYSON PROPERTIES, L.L.C.
Applicant: GRAYSON PROPERTIES, L.L.C. .
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
d / ----
Li c I, ,„. (4.4.,
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: P20010816 Application Number: A20010816
Tax Map No: 523400-296-013-0001-073-000-0000
Permission is hereby granted to: LAWRENCE GRAYSON
For property located at: 73 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. Type of Construction Value
Owner Address: LAWRENCE GRAYSON Septic Alteration Residential
1004 CHESTNUT St Total Value
MECHANICVILLE,NY 12118
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY.NY
Plans &Specifications
2001-816 LOT#20 MONTRAY ROAD
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday, October 31,2002
(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 Town of ueensbuty Wednesday, October 31,2001
SIGNED Y for the Town of Queensbury.
Director of B • g Code Enforcement
Application for.Permit—Septic Disposal System
T own of Queensbury 7•12 Bay Road Queensbury, NY S ' To"
1. OWNER INFORMATION: ,/
a 7# �(� Office Use
Location of installation:
Tax Map No. / / WN liPridinileY10/
�.- .�,CODS .
Owner's Name: ee Paid '
Co,.o, r r C/"o c o✓l0
Address:W /®G c tc r..7
c S'"Nc.Ai S/, /"1 c c4 0-4./C t/i G(C
2. INSTALLER'S NAME : t 0, J rep (,/t, PHONE NO. Wif----afili V
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate il 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 Daily Clow
. 1980 or older j x 150 gal/bdrur =
rt a
1980— 1991 x 130 gal/bdrnr =
1991 —present x 110 gal/bdrin =
•
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Topography Soil Nature Ground Water_ Bedrock or impervious Material __Domestic Water Supply
lrlat Rind at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is f.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
'I
— 5. 1?R iPPOSED SYSTEM; Tor New Conslruclion: 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: (50° gallon (min. size 1,000 gal)
Tile Field: each trench 1t. Total System Length: ft.
Seepage Pit(s): number of J size of each: ft. by / 0 11.
Size of Stone to be used: I/ 3 / depth or thickness "j-N__ 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 tho 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 To a of Queensbury Sanitary Sewage Disposal Ordinance.
i\\ W ' - .
• ,.._46,c,
1® ��
Signature of responsible person Date
I/1c)
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
•
Name sOlCk , P,K1eQ ,C -�
Locati one> - ao M an-
Date l j - �- O) Permit # I "-� l (.P
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - c ft. x ifl ft.
Stone size Lt c,
PIPING: Sire yp e
Bldg. to Tank • r',
Tank to D ss-
"-to Field r� ► �
Openings Sealed? N. Partial
LOCATION/SEPARATI
Foundation to Tank . feet
Foundation to Absorption . feet
Separation of Pits feet
Conforms as per Plot Plan e o
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - eft - '"gh Side
Middle Front - e Rear
COMMENTS:
P?9\3k)1E—k
•
ate ,,-dot
SYSTEM.USE APPROVED: ES NO
Arrived:
Departed:
. B spector
___ is— 9_u' n., - --- - -- - —
r i f ave seen or o s rve., o e !eve s w e idepce of,
-- -' 0 E____,, , -ail- bje 4s-such as � !se;t: tls tre, , enr;,,, tc., - -
< 5l s h o Il l 4�1CL!�Lr r•n p
03 !_: . o-,ter s: r-th l lav -
_60 �°�1 per onalfy r- asureai thr di-tances set forth on 'he diagram."
\ "-j I,. S.k;,-rthl - --li F-E / A T-E c'' . 1
(usA , A (,-,- , ___] - L____
i iiir
, i—g._.. , ,..,.::.
I 1 • rsi i
k
I
7.J-N
`Q c—' C_______0 0 gl.s ,
cobtI ci
37
7)
9 of ,�, �— —
—e, m — �-
AZ
2 "Ti
1 >c rn 7- I
8 rt 19 1'- {
1--- —