2001-908 z TOWN OF QUEENSBURY
742 Ba Road ueensbu NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010908 Date Issued: Thursday, December 13, 2001
This is to certify that work requested to be done as shown by Permit Number P20010908
has been completed.
Tax Map Number: 523400-295-018-0001-082-000-0000
Location: 86 AVIATION Rd
Owner: RUTH STARK HILL
Applicant: RUTH STARK HILL
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
f1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010908 Application Number: A20010908
Tax Map No: 523400-295-018-0001-082-000-0000
Permission is hereby granted to: RUTH STARK HILL
For property located at: 86 AVIATION 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: RUTH STARK HILL Septic Alteration Residential
86 AVIATION Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
BAPP'S TRUCKING& CONTAINER SER
TROY BAPP SR
NY 12804-0000
Plans & Specifications
2001-908
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,December 12,2002
(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 To • of • een ry W t day,December 12,2001
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SIGNED BY ! for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System
Town of Oueensbury 742 Bay Road Oueensburv, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
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Location of installation: (� 1 p), (,
o` d Office Use}_ )0
File Permit N ( I U
Tax Map No. 83 /" Z / Z dc?
�y,j� � 5,�� Fee Paid
Owner's Name: NA, Sir,k, fA
Address: g- 19/G A`D i P a2 v' - O Z4-
720-OF 7S
2. INSTALLER'S NAME : 7 )J .F4/ , PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
c-C1-980 or olde ._< x 150 gal/bdrm = 1/" U
1980-1991 x 130 gal/bdrm = RECEIVED
1991 -present x 110 gal/bdrm = �+
Garbage Grinder Installed yes_ / no I)'f' 1 I 20Q1
Spa or Whirlpool Installed yes / no Cam ® ;;c�UN: NS8l1RY
J11� lf(__ND CODE
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
0 ography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Su 1
Plat ssaanndd at what depth at what depth munictpa
Rolling
dam feet feet we 1
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: l( gallon (min. size 1,000 gal) �J
Tile Field: each trench ft. Total System Length:ago ft
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / 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.
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Signature of responsible person Date
11111
TOWN OF QUEENSBURY .
BUILDING._&._CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name - 1Li _ (e)cc )
Location �(, f)‘3%f—T-«�� e\)
Date AK ' —() Permit # 2c
SOIL TY'Air nt.,- lay-
Results . Perc9lation Test-
(if appli.able) 'Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION IELD: Total Length . 2
Length of e.ch tr:nch `h Cam i-d
Depth of tre ches ,7 i
Size of stone .
SEEPAGE PITS: Nu •er-
Size - 1\. ft x ft.
Stone size
PIPING: Size Type
Bldg. to Tank L%
Tank to Dist. Bo L." frei‘774-°n
Dist. Box to Fiel Pi %% CCU
Openings Sealed? 4ft No artial
LOCATION/SEPARATI .
Foundation to Tank 1D feet
Foundation to Absor tion -z feet
Separation of Pits feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERT
(circle one)
Front - Rear - L Right Side
Middle Fron - Riddle Rea
COMMENTS: -
SYSTEM USE APPROVED: 40511 ; r
Arrived:
irdtis
Depart /
— . '.y,�
u di g Inspecto '
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL—SYSTEM INSPECTION
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Name /
Location 8 'cv('J1-,_-g2Z--
Date / id- b/ Permit # ( > /- 9611
SOIL TY : Sand- oam-Clay-
Results of Percolation Test-
(if applicable) Ra - Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length 71-Xj (JC
Length of each tren h •. geA)7
Depth of trenches
Size of stone
SEEPAGE PITS: Numbe -
Size - ft. x ft.
Stone size .�
PIPING: Size Type
Bldg. to Tank l-1 y d 5L o
Tank to Dist. Box p\I.
Dist. Box to Field 'it L _;,-,;i_..k,V1 L- c-
Openings Sealed? Yes No Partial
LOCATION/SEP} a1'TIONS:
Foundation to Tank 10 feet
Foundation to Absorption _zd .feet .
Separation of Pits feet
Conforms as per Plot P1 an — eJ No
LOCATION OF SYSTEM ON PRO'ERTY:
(circle one)
Front - Rear - - . •: - Right Side
Middle }=rent - Middle Rea ,
COMMENTS:
\LS 1 t
°t' CooM ----ccsa
SYSTEM USE APPROVED: YES (JO)
Arrive : 7�,y fib.
Depar` ed: ;
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CD =wn "I have seen or observed, or believe I saw evidence of, 7 I
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coo all objects such as houses, wells, trees, fences, etc., la Oh
zo shown on this document. I also represent that I have W----Q° i
-�- r' "'a personally measured the distance set forth on the diagram."
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