2000-792 TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 (5I8) 76I-8201
Community Development - Building & Codes (518) 761=8256
C
E.... .. IFICAT'E OF COMPLIANCE
Permit Number: P20000792 Date Issued: Wednesday, October 11, 2000
i
This is to certify that work requested to be done as shown by Permit Number P20000792
has been completed.
Tax Map Number: 523400-114-000-0001-015-000-0000
Location, 4 GRIFFING PI
Owner: MICHAEL & CHARLOTTE DALY
This structure may be used as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Director of Building& Code Enforcement
TOWN OF QUEENSBURV
Et 742 Bay Road, Queensbury, NY 12804-5902 (518) 761 -8201
Community Development - BuiIding & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20000792 Application Number: A20000792
Tax Map No. 523400- 1 14-000-0001 -015-000-0000
Permission is hereby granted to. MICHAEL & CHARLOTTE DALY
For property located at: 4 GRIFFING PI
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 Qucensbury Zoning
Ordinance. _Type of Construction Value
Owner Address: MICHAEL & CHARLOTTE DALY Septic Alteration Residential
4 GRIFFING Pl Total value
QUEENSBURY, N.Y. 12804
Contractor or Builder's Name 1 Address Electrical Inspection Agency
Plans & Specifications
Septic Alteration (Residential)
Tax Id No. 1 14.- 1 - 15
4 Griffing Place
3 bedroom House
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday, October 11 , 2002
(1f a longer period is required, an application for an extension must be trade to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town o ue bury W dne y, October 11 , 2000
SIGNED BY for the Town of Queensbury.
Director of Building & Co Me En cement
Application for Permit — Septic Disposal System C'JC
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1 . OWNER INFORMATION: k
_ Location of installation: __ ! �.._.��!` r�_._..��'rt.�` C.0 e Orrice Use
Tax Map No. 1 Ll d File Permit No,
Owner's Name C 4CAr C CW
F�e,ga`i
Address:
2. INSTALLER'S NAME / . P140NE NO. 7,o) T
3. RESIDENCE INFORMATION: (circleyear of dwelling, indicate # bedroom(s) and multiply 4 of
bedrooms with applicable gallons per bedroom to equal total dady,/lvw)
Year of House: No. of Bedrooms x Computation — Total Daily Flow
1980 or older x 150 gai/bdnn
1980 — 1991 x 130 ,gal/bdrm = r
1991 — present x 110 gal/bdrm =
Garbage Grinder Installed yes ! no
Spa or Whirlpool Installed yes I no
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
rA GroundWater Bedrock or Im ery�us ,Material D in"s ic 'Water Supply
I%7n1jfa at whu epth at w a epth ' rpexf
ing eet eet well
Steep slope clay 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, Azd 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 Planting Board approved subdivision). Add 250 gallons to the sizc
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub,
Septic Tank: gallon (min. size I, 000 gal.)
Tile Field: each trench ft. Total System Length fl.
Seepage Pit(s): number of size ofeach: fl. by fi.
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 l 36-29 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.
II have read the regulations with respect to this application and agree to abide by these and all
requirements of the wn of Queensbury Sanitary Sewage Disposal Ordinance.
gnature of respons le person Date
SUTOWN OF QUEENSBURY
ILDINlG & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 1_2864
T(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date wz� %a yrrni t # `
SOIL TYPE: tand/—Zoamasa,C7ay-
Resulis ofcol ati on Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total LeAgt
Length of each 'trench , j`—
Depth of trenc es T
Si kk
ze of stone
SEEPAGE PITS : mber-
4 all
Size - ft . ;< ft .
Stone size _
PIPING: - Size Type
Bldg . to Tanker
Tank to Dist . Box
Dist . Box to Field/P
Openings Sealed ? Ye o Partial
LOCATION/SEPARATI -
Foundation to Tank/ ~�feet
Foundation to Absorption feet
Separation of Pits eet
Conforms as per . Pl of Plan es No
LOCATION OF SYSTEM ON PROPER
( circle
Front - - of Side - Right Side
Middle 'Front _ M df d1 a Rear
COMMENTS *
SYSTEM USE APPROVED -: Y S NO
Arrived :
Departed;
Building Inspector
Michael Daley 2000
4 Griffmg Place ?
SEPTIC SYSTEM PERMIT
Tax Id No. 114.4 - 1. 5
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I h ve seen or observed, or believe
f
all o iects such as houses, saw evidence of,wells, trees, fences, etc.,
n an this document. l also represent that f have
Person lly ►Measured a distances set forth on the diagram. "
SIGNATURE DATE