2001-708 6 TOWN OF QUEENSBURY
F
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010708 Date Issued: Wednesday, September 19, 2001
This is to certify that work requested to be done as shown by Permit Number P20010708
has been completed.
Tax Map Number: 523400-279-000-0001-051-000-0000
Location: 950 STA'1'F ROUTE 149
Owner: JOHN&EDITH BOWMAN
Applicant: JOHN& EDITH BOWMAN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(DJ 11
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
11%
f.T 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010708 Application Number: A20010708
Tax Map No: 523400-279-000-0001-051-000-0000
Permission is hereby granted to: JOHN&EDITH BOWMAN
For property located at: 950 STATE ROUTE 149
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: JOHN&EDITH BOWMAN Septic Alteration Residential
950 STATE ROUTE 149 Total Value
LAKE GEORGE,NY 12845
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans & Specifications
2001-708
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday, September 19,2002
(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 own QuI Viry; y, September 19,2001
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic o Dis sal System
Town of Queensbury 742 Bay Road Queensbury,Disposal 12804,(518) 761-8256
1, OWNER INFORMATION:
Office Use
Location of installation: (7%,..5-0 5 4 P 2 /'�
Tax Map No. / / NEI-e e 'rit o !® / 2!SD
Owner's Name: 0 gee Paid �--�-
�v
2001
Address: qs-0 S—f r 7 Peu1, 1 g q T IN
2. INSTALLER'S NAME : \,7,_1 Ar^_a Sa., d`- °y PHONE NO. q o
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedrooms),and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No, of Bedrooms x Computation = Total Daily Flow
�`19809xolde� Z x 150 gal/bdrm =
1980— 1991 x 130 gal/bdrm• =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes /CiF
Spa or Whirlpool Installed yes / oib
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supper
san at what depth at what depth cipal
Rolling loam feet feet ( s
Steep slope clay if well; water supply
_%slope other from any septic-system
• depth: absorption isle _ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
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:/0 c' gallon (min. size 1,000 gal)
Tile Field: each trench ` dt 4" ft. Total System Length: /? 2- ft.
Seepage Pit(s): number of_ size of each: fl. by _ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: j lr ..5 ( v ct KE 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) i ,I
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.
O
&ti,
Signatur of responsible person Date
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name W\ kQAr
Location R-)-- ) 91
Date ' — rW C)Permit # g
7O
SOIL TYPE: Sari -Loam-Clay-
Results o&Bercola e Test-
(if applicable) 11 -te *lute/Inch
______+
TYPE OF SYSTEM:
ABSORPTION FIELD Tot:1 LengIK (72
Length of each t enc k 341
Depth of trenche
Size of stone
SEEPAGE PITS: Nulr-r-
Size - ftlrx ft.
Stone size
PIPING: size Type
Bldg. to Tank, ' T/A.,
Tank to Dist. Box —
Dist. Box to Field/ 5z-02_12 ,
Openings Sealed? /11 No . Partial
LOCATION/SEPARATIO . „)A
Foundation to Tank feet
Foundation to Absorptisn PI feet
Separation of Pits feet
Conforms as per Plot Plan Yes , No
LOCATION OF SYSTEM ON PROPER \ :
(circle
Front Rear Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
i f‘
VJC-61-- e — c <
SYSTEM USE APPROVED: YES NO
Arrived: 74
Departed:
Building Inspector
,
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RECEIVED
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SEP I 8 2001
TOWN OF QUEENSBURY
BUILDING AND CODE ..
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