2000-728 TOWN OF OUEENSBURY
742 Bay Road, Queensburv, NY 12804-5902 ('318) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLI-A.N. CE
Permit Number: P20000728 Date Issued; Tuesday; September 26, 2000
This is to certify that work requested to be done as shown by Permit Number P20000728
has been completed.
Tax Map Number: 523400-066=000-0003-001-000-0000
Location, 35 WINCREST Dr
Owner; PETER G. KINDERSLEY
This structure may be used as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
W /
Director of Bui]ding & Code i9forceAnt
TOWN OF QUEENSBURY
CL 742 Say Road, Queensbury, NY 1 2 8 04-5 402 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number. P20000718 Application Number: A20000728
Tax Map No: 523400-066-000-0003-001 -000-0000
Permission is hereby granted to: PETER G. KINDERSLEY
For property located at: 35 WINCREST 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: PETER G. KINDERSLEY Septic Alteration Residential
35 WINCREST Dr Total Value
QUEENSBURY, NY 12804
Contractor or Buiidees Name / Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans & Specifications
2000-728
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday, September 22, 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 VfQuftpsburn Friday, eptember 22, 2000
SIGNED BY for the Town of Queensbury.
Director of Building & e orcement
r'
Application for Permit -- Septic Disposal System
Town of QueenSbury 742 Bay Road QueensbuM NY 128d4 (518) 761-8256
1 . OWNER INFORMATION:
f_.,,.,._................................_„_......_.................._....................................................._.....,
Location of installation: 1 " ! Office Use
..
Tax. Map No. / / � File Permit No. � `
Owner's Name: �. r Fee Paid r. e "-V5
5 car
_ ... .. . ................. .. .._....,,.,.
Address: ..
2. INSTALLER'S NAME PHONE NO. l`
3, RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply # of
bedrooms with applicable gallons per bedroom to equal total dailyflow)
Year of Has : No. of Bedrooms x Compgjktion = Tcrtal ail Flaw
1980 or older _ x 150 3gaVbdrnx = _ ---�-
1980 — 1991 x 130 gal/bdrm =
1991 — present x 110 gaVbdrm =
Garbage Grinder Installed yestr1
Spa or Whirlpool Installed yes
S P
4. PARCEL INFORMATION: (circle applicable information & indicate measurenionts)
x it N re round Water .Bedrock r 1 a us M teri 1rfrom
ester u 1
at what depth at what depth l
offing oam feet feet
Steep slope clay water supply
slope other y septic-system
depth: ptlan is ft.
other
Percolation Test: (To be completed by lice ed professional engineer or architect)
Rate: minute per inch t sF., C( �y� ;4 S y S - t C rv% j
t ` D /LG s 4Wr I +3--rHt %4 Si ),I /c
5. PROPOSED SYSTEM: I'or Ne C'onsin ction: 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.
e2LS
peptic Iank;/(_o gallon (min. size 1. 000 gal.)
Tile Field: each trench f. Total System Length: 1 �?.
Seepage Pit(s): number of size ofeach: f7. by fi
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: lli i fi length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks- 1 Size of each: gallons I 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.
Si star responsible person Date
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Say Road
Queensbury NY 12BO4
(sis) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date ` Z� - 1Permi t # Z.CA2,j =— .
SOIL TYP Cla
Results of Percolation Test-
( if applicable ) Rate-Mlnute/lnch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length Aza
Length of each trench x ,
Depth of trenches 3
Size of stone 13�1FLP►'fr`���
SEEPAGE PITS . - Nuhipber-
Size - ft . N ft .
Stone size is,
PIPING : ype
Sldge to Tank = ti ,/
Tank to Dist . Box
Dist . Box to Field it
Openings Sealed ? es o arm a�
LOCATION/SEPARATI 101FI Li ,
Foundation to Tanis -- feet
Foundation to Absorpti a1-feet
Separation of Pits feet
Conforms as per Plot Plan es Ao
LOCATION OF SYSTEM ON PRO
( circle one )
Front +�,fir - Left Side ht Side
Middl a �---fi9iddl a Rear
COMMENTS :
SYSTEM USE APPROVED:
YES
�~_--- -
NO
A - u � d
r
x
Q0
t.i
30
r
[�
to
Cl
lr- �
S
9 G,
rJ
uj
2�
Eobjects
een or observed, or believe I saw evidence of,
such as houses, wells, trees, terrces, etc.,
this document. I aiso represIr ?t that I have
y measure he dista ices set forth on the diagram."
3I ATURE DATE