2000-883 TOWN OF OUEENSBURY
742 Bay Road, Queensbur,;, NY 12844-5902 (518) 761-8201
Ct Community Development - Building & Codes (518) 761=8256
CERTIFICATE OF COMPLI'A.N. CE
Permit Numbere, P20000883 Date Issued: Tuesday, November 21, 2000
This is to certify that work requested to be done as shown by Permit Number P20000883
has been completed. [pq wa . Y7
Tax Map Number: 523400-069-000-OOO2-002-000=0000
Location: 4 OAKWOOD Dr
Owner: PATRICIA SINGLETON
Applicant: PATRICIA SINGLETON
This structure may be occupied as a:
By Ordu of Town Bp atd
Septic Alteration Residential �tUE s
Director of Building & Code Enforcement
R
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Community Development - Building & +Codes (5I8) 76I-8256
BUILDING PERMIT
Permit Number: P20000883 Application Number: A20000883
Tax Map No: 523400-0+69-0000--00062 (1210 09' f
Permission is hereby ,granted ter: PATRICIA SINGLETON
l'or property located at: 4 OAK WOOD 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. T of Construction Value
Owner Address: PATRICIA SINGLETON
4 0AKWOOD Dr Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builder's Name / Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans & Specifications
2000-883
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday, November 17, 2002
(Ifa 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 t Fr' y ov ber 17, 2000
SIfNED BY
for the Town of Queensbury.
Director of Building & Code Enforcement
,,t
Application for Permit - Septic Disposal System
TOW" of Queensfiury 742 Bay Road Queenshurv, NY 12804 (518) 761-8256
1 . OWNER INFORMATION:
_................. .............. .................
Location of installation: Office Use
Tax Map No_ I I File Permit No.C�hLQ
Owner's Name: Fee Paid — - `-- —
Address: !
2. INSTALLER'S NAME : ftJ
PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(y) and multiply # of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x
Com utakion Total Dai! Flow � p
1980 or older Ef 1V' ED
1980 — ! 991 x 150 gallbdrxn = c`i '>
1991 — present x 130gal/bdrm = NOV 1 7 200i1
x I I U ,S'al/bdrm =
OF Garbage Grinder Installed Bt1♦�NG AEEI�BBUF�Y
Spa or Whirlpool Installed yes I no Nb CUC7E
ye / no
4.
PARCEL INFORMATION: (circle applicable information & indicate measurements)
T ra h So ure Vi
Water Bedrock or I ervious Material Dorn
sand depth at what depth stet Supply
Rolling oam unici ad
Steep slope clay feet _..._.feet
%¢ slope other if well; water supply
depth; from any septic-system
absorption is f,
Percolation Test: (To be completed by licensed professional engineer or architect) other
Bate. minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed professional engineer or architect (unless installed in a PlanningBoard a gn by a licensed
of the scptic tank and leach field for each Garbs e G ' approved subdivision), Add 250 gallons to the size
A. b' rider, Spa or Whirlpool Tub.
Septic Tank: f 000 gallon ("ruin, size 1, 000 gal )
Tile Field: each trench -t=-L ' . .f} TotaI System Length: t
Seepage Pit(s). number of— /pr
�_�---� size of each: ft. by
Size of Stone to be used: #
1A %" depth or thickness feet
Bed System Size:
Alternative System: ' 1 COP/GR r f F j7
_� length and/or size �p f .r [
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: I 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 I36-29 of the Code of the Town
Of Queensbury, any permit or approval reliance upon any material granted which is based upon Or- is granted in
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 a Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of respansi le l " r� � C?•�
person
Date
BUILDIIy �E NSBURY
FOBESN 7
4eensb !Road
-�___�y NY I2gU4
(519) 761-9256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date ! � t Permit ,#
° Solt TYPE
San
d1 oam-Clay.
�if Ua is of erco7 a tion Tes _
applicable ) Rate-Mina
A SB TYPE
RpTION a/I h c h��/
Length o�ache Total engt
Depth of Lrenche Tench
Size of stone —�--�—
SEEPAGE PITS,': um r-=
Size r
Stone size ft ' xft , --
PIPING - _
Tank Bldg. to Tank ~ 3 e
Dis to Dist . B x
DpeninPox to Feld/P • t r 7z)
Lod.ATl gs Seal $
FOundatio/SEP TrON o art a
Foundation t Tank
Separation R1s0rption /� V feet
Conforms a t" Fits �� eet
L0CATIOR per Plat Plan �eet
!circle SYSTEM ON PROPERTY. e No
Front
Middle Fre r Left Side
Cols; t Middle Rear r Right Side
' �tC�o%tJ
f'7" C.a1L1 t%S
SYST" USE APPROVED:
Arrived: YES so
Depa r-ted: -
i
But din
9r Inspector
-- - -- - - TOWN OF QU,EEN.SBURY
—BULDW4G ODE I S)� DEKT.
F( I r (m% npy
REVIEWED BY �-
DATE
T" OF %ffNSBWY Bt1li.[ W DEPARTMENT
Based on our ignited emotion,
ooerOie "Vm our cmwmft shall
, j riot be construed as indilca6V the
, plans and sticns are in full c+omplkInce wit I Ile anode.
x / v
NOV 1 7 2000 c
TOWN OF QUEENSSUR-`i'
BUILDING AND CODE 7
� s . r )
,3O
"I have .spen. or observed, or believe I saw evidence of,
f all �1,; r; : ;, rs as I,t"uses, tiv¢IIs, tr es, f2r�ces, etc.,
JO i.i T-' n 131SU resent that I have
s as .E aspired e d es set forth on the diagram.
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SI ArURE DA E
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