2000-793 TOWN OF OUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 (518) 7614201
Community Development - Building & Codes (518) 7614256
CERTIFICATE OF COMPLIANCE
Permit Number: P20000793 Date Issued: Friday, October 13, 2000
This is to certify that work requested to be done as shown by Permit Number P20000793
has been completed.
Tax Map Number: 523 -1q3 w P-C; 1 - a-M
Location: 9 SECOND St
Owners, MARGARET H MC CLURE
This structure may be used as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Director of Building& Code Enfor ernent
TOWN OF QTEENSBURY
(aw 742 Bay Road, Queensbury, NY 12804-5902 (518) 761 -8201
Community Development - Building & Codes (518) 761-8256
13UILDING PERMIT
------------
Permit .Number: P20000793 Application Number: A20000793
Tax Map No: 523400- 134-000-0006-012-000-0000
Permission is hereby granted to : MARGARRET H. MC CLURE
For property located at: 9 SECOND St
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. Tyne of Construction Value
Owner Address: MARGARET H. MC CLURE Septic Alteration Residential
P-0. BOX 226 Total Value
GLENS FALLS, NY 12801
Contractor or Builder's Name 1 Address Electrical Inspection Agency
CONDONS SEPTIC & DRAIN SERVICE
Plans & Specifications
Septic Alteration (Residential)
9 Second Street
Tax Id No. 134.-6- 12
2 bedroom house
$25a00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday, October 13, 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 Tow Qu nsb ; , ri 13, 2000
SIGNED BYI� for the Town of Queensbury.
Director of Building & Code Enforcement
Application for Permit - Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1 . OWNER INFORMATION: .............._,............_......................................,,,_..,-.........._......................
__. ,
office Use
Location of installation:
3 , f 01 f , y File Kermit No. nzo
y`-
Tax Map No. `'+�j �..� ^
Owner's Name: Ct L U 9Q Fee Paid
3
�c . . . .......... ... . . .. ................_................
..... ....................�
Address: N c d {
2. INSTALLER'S NAME 1� �i►11 S .3 .� � � G PHONE NO. Z -
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily ow)r?4Y�
Year Qf Housm No. of Bedrooms x u on = Total Daily Flow
1980 or older x 150 gaVbdrm = aC9
1980 - 1991 _ x 130 gal/bdrm =
1991 - present x 110 gali'bdrm =
Garbage Grinder Installed yes _ 1 no
Spa or Whirlpool Installed yes — ! no -
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
!oTing
it ur un Wat r B droc or l ervio s Material Dom stic Water u l sand at what depth at w at depth mu ct a loam feet feet well
Steep slope clay dwell; water supply
_% slope other from any septic-system
depth: absorption is
other
Percolation Test: (To be completed by licensed professional engineer or architec )
,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: W 6gallon (min. sine i,000 gal-)
1
Tile Field: each trench -!5r�af7 Total System Length: }BLS ft.
Seepage Pit(s): number of size ofeach: fi, by .
Sine of Stone to be used: i! / depth or thickness feet
Bed System Size: x
Alternative System, length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks; 1 Size of each: gallons f 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-
Signature of responsible person Date
TOW OF QUEENSBURY }
BUILDING & CODE ENFORCEMENT
742 Bay Road L
QueenSbury NY Z2804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name D✓►
Location
Date Permit #
SOIL TYPE: 'Sand Loam-Clay-
Results o col ati on Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION 'FIELD : To l Le th, G �
Length of each trench i
Depth of trenche
Size of Stone 4L 7
S
SEEPAGE PITS : Numbe -
Size ft . x ft.
Stone sue-- _
PIPING : — S�-e fype f
Bldg . to T �ank rl
Tank to Dist . Box k t l CJ
Dist . Box to Field/
Openings Sealed? es No aP rti al
LOCATION/SEPARATi
Foundation to Tank feet
Foundation to Abs rption feet
Separation of Pit et
Conforms as per Plot Plan es No
LOCATION OF SYST�[ fl�1 _pRQP.ERT .
( circle one ) -
Front - Rear - &Left Sid Right Side
Middle Front - Mi a Rear
COMMENTS :
SYSTEM USE APPROVED : I YES NO
Arrived:
Departed :
Building Inspector
0
have seen or observed, or believe 1 saw evidence of,
v all objects such as houses, �r�ells, trees, fences, etc..
VEC a shown on thtis iocurrlent. i also r 'sent that 4 have
IIIII UNION
personally measured the distances set forth on the diagram."
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