2000-523 T' C3'W'N OF +QUEENSB►UR.Y
742 Bap Road, Queensbury, NY 12804-5902 (518) 761 -8201
Community Development - Building 8c Codes (518) 761-8255
CERTIFICATE OF COMPLIANCE
GjC Nutnber• C20000538 CjC Date: Tuesday, August 08, 2000
Application. Number: A=P20000523
2-00000538
e.
Permit Number:
This is to certify that work requested to be done as shown by Permit Number P20000523
has been completed.
This structure may be used as a Septic Alteration Residential
Tax Map Number: 523400-081 -00+0-0005-001 -000-0000
Location: 4 LYNNFIELD Dr
Owner: ROBERT & ELEANOR SHAW
B Ort(QuE
Town Board
Ty 5BT.JRY
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
BUIEDING PERMIT
Permit Number: P20000523 Application Number. A20000538
Tax Map No: 523400-081 -000-0005-001 -000-0000
Permission is hereby granted to: ROBERT & ELEANOR SHAW
Owner of property located at: 4 LYNNFIELD Dr
in the Town of Queensbury, to construct or place a Septic Alteration. Residential
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.
Owner Address: ROBERT & ELEANOR S14AW
4 LYNNFIELD Dr
¢, QUEENSBURY, NY 12804
Contractor or Builder's Name / Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Type of Construction: Septic Alteration Residential Value : $
Plans & Specifications
$25,00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday, July 24, 2002
(lfa Sanger period is requited, 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 ens r551 M SA July 24, 2000
t. SIGNED BY /01 for the Town of Queensbury.
Director of Building & Code Enforcement
Aplllicatiolt Colo term( - 5eptly Disposal System
1'01VII of Quecriubt►►;y 7.1213rajr NJ' 12804 (.518) 761-82.S6
1. OWNER INFORMATION:
_._.._ w ,.. _ _......._..._...............•..
Location of installation: �,rr�-rAJ fr'J� � ri
!c 6 l t1 C Ufce Use
Kilo forttrit Now
Ow+tar's Nnute: 'f�ft ^w Fee Paid
Address: EY E oL
2. INSTALLBR'5 NAMI3 =722a PHONE NO.
3. RCSIDCNCC INFORMATION: (circlo jpe rr 0rciweliiiig, iliclr•c:rrlej# 11 bcerlrra()►Irl:sjl hiitl rmaltil)Iy 11 raj'
becl►-o4o r.s with applicable T.rrllurrs liar berkown to e(ioal Irrlyd dailjpflutr)
o"tr or I is se a or Uedraol Is x _ ott�la«lFlo( 'Patti Daily l?lo►v
1980 or older - x 150 IF,atljbdrrlt w C] O
1980 — 1991 x 130 gal/btlrm
1991 -- l}resent x l l0 f;al/belt Ira
Garbage Griutdnr Installed yes � ! rro
JUL 2 4 2000
Spa or Whirlpool Installed yes I I+v
4. PARCEL 1NF0RXAATI0N: (circle applicable iter'orrttatiort & i+rdi,cat.c>
-t 19l o1r1. moo urr�,,., [ ir trltcl�Wricr i3ccli'o4k _c+�l��?iactvic �s l L�einl 1) is W�t[ci_5liprtly
7rtf rFlee`
► rN r+thrrl efrrlrrlr o/ whrrr rlerrlh Are rrra tic lip,r►
`otu)091�1Ig rrrrra+ fief fate! rse T
steely slolle clay if well; wetter xseiglly
� slope outer fi•rrnl any .sceptic-system
depTlr; rrbso►la►Fall is f1.
other .
Porcolatioll Test: {1 it be Crrrnlrlrlcd by licelrsed p►vrfc.ssivlrrrl eltl;Irrec}r rrI ericlrlTeac►f
Rate: 11111111t a per /lici►
5. PROPOSED SYSTCM: Tor New Constrisdiort: All individoal sew me disposal sysicios most be designed by ts liccnscd
professional onginccr or arclatt et (littless inswiled hr a 1'I:alnlilin 130a9d agalnoved subdivision). Add 259 l tsllotis to Ilac sire
of the septic i:snk and Ic:aclr field liar csich Gaobage Gl inder, Slits or W Itir IlIsMI '1'nb.
yy"""
Septic Tai[k: r-'"yLi crllvlr (mill, size 1, 000 Serf.)
'file Yield: each french ji. 'fatal System Lejigilr:
Seepage Pit(s): rrrenrber of size (J'eac1I. ft ley it,
Size of5twto to bo ttsed: 11 / dej)lh or fhlckrtr.t:w
Bcd System Size; x
Alternative System: 1e►rglis c milor .whe
G. HOLDING TANK SYSTEM: (if required)
NumborofLanks: ! Size oreacll: gallons / T9l"AL Capacity: gallons
Note: Alarm System and associated electrical work mast be inspected by a 'fown approved
clectricai inspection ageltcy.
7. SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON ())tease read)
For your protectioat, pleaso note iliac pxttsxsnrrt to Section 136-29 of fire Code of tho •!•own
orQtreettstomy, arty hermit or rtpprovnl IVentsted Which is bnsed ttltvrt or is I,rstnted in
talin tic o ulPoet nit III ate IinI mint vItr env' aatioal <tr Inilttro rtx matkca a +tialesinI rnct. or
circumstanco Ste aowrt by or' on behalf or oar appIicnait, shall be void.
1 irnvo tenet alto r-nntrintiurts Wialt te.elaert. Iv shads selel+licnrieat natrl atseoe eta raaaitao Ivy ateso naatl air
requirem;qn�hture
fuse Towle or (,Zllevosbury Saltitaay Sow"go Disposal 01dinstr+ce.
ad:AA 9�0.PT) Ado JA�
of res sable person Dar
TOWN OF +QUEEKSBURY
BUILDING A CODE Elf FORCEMEMIT
742 Bay Road
QUeensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location1 �`�,
Date — ' ,�-LY1 ermi # _-T
SOIL. TYP Sand- L am-Cia -
Results of Percol ti on T st-
( if applicable ) Rate-Min to/ Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : otal en th �
Length of each tre ch
Depth of trenches
Size of stone
SEEPAGE PITS : Numb -
Size - ft , x ft .
Stone size
PIPING: Size ype
Bldg . to Tank
Tank to Dist , Box I
Dist . Box to Field/Pi ;
Openings Sealed ? Yes o artial
LOCATI OM!/SEPA RATION 5 :
Foundation to Tank I feet
Foundation to Absorption feet
Separation of Pits et
Conforms as per Plot Plan es a
LOCATION OF SYSTEM ON PROP
( circle
Front - Re - f��ight Side
Middle��r
COMMENTS
i
SYSTEM USE APPROVED: �,� O
Arrived.
Depa
i ng nspe ore
:• "! have seen or observed, or believe I saw evidence of,
alf '� 5 ;UCH noS, 04S, f?F fE'f C45, tC.,
. '3 f ,r• rer�S�TI� tli8 f {i{?�GfYQ' a i ii 1T
4
f 0
r: DAT
TOWN OF QUEENSBURY QCoo
i 131`„IILDING &
REVIEWED BY JUL2 4 2000
DATE
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