2000-924 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20000924 Date Issued: Tuesday, February 20, 2001
This is to certify that work requested to be done as shown by Permit Number P20000924
has been completed.
Tax Map Number: 523400-110-000-0001-002-003-0000
Location: 765 QUAKER Rd
Owner: COMMUNITY WORKSHOP INC
Applicant: COMMUNITY WORKSHOP INC
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Commercial TOWN OF QUEENSBURY
1/—
Director of Building& Code Enforcement
AliAik• TOWN OF QUEENSBURY
` 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
v.,0
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20000924 Application Number: A20000924
Tax Map No: 523400-110-000-0001-002-003-0000
Permission is hereby granted to: COMMUNITY WORKSHOP INC
For property located at: 765 QUAKER Rd
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: COMMUNITY WORKSHOP INC Septic Alteration Commercial
PO BOX 303 Total Value
GLENS FALLS,NY 12801
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans &Specifications
BP 2000-924
COMMERCIAL SEPTIC ALTERATION AS PER PLOT PLAN
AND SPECIFICATIONS
$35.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,December 13,2002
(If a longer period is required, an application for an extension must be made to the code Enforcement
Officer
Dated at the Tow r ns• W !�' 'ecember 13, 2000
it
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
• Application for Permit—Septic Disposal System
Town of Queensbwy 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: 76 5
/ Office Use
Location of installatio • Li >�c r
tt File Permit No.C%�-�UCJ— J
Tax Map No. //U/ / /
Owner's Name: (', �� �' Fee PaidC�.
Address. r C�
DEC 072000
2. • INSTALLER'S NAME : qv
_lam � c Sc �(' r`� � TOWN cI' ON.E NO. ?/0
�Bt1i�Dl r aaoiwc SSUt \,
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#beefs on( ate 'ultil ly!! yr
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of klouse: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdnn =
1980— 1991 x 130 gal/brim =
1991 —present x 110gal/bdrm
Garbage Grinder Installed yes / no DEC 0 7 2000
Spa or Whirlpool Installed yes / no =✓
TOWN OF O fEEt SBUBY
BUILDING AND CODE
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Qi.I�flLSlS9 QiQ4tnd . .omcsf Wa er_$�ipply
l'fat sand at what depthat what depth u►ictl_crL—>
ng loam feet _feet well
Sleep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: -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 n licensed
professional engineer or architect(unles&installed in a Planning Board approved subdivision). Add 25A gallons to the s'r.e
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub. iCi'l4 t I 76-36,
Septic TankPO0 a gallon(min. size 1,000 gal) j
q:(\(17-7/.416"
8d �6� (�Cc� o cleld; each trench r �' 0 ft. Total System Length: fl.
Seepage Pit(s): number of size of each: ft. by
( i1I .0 c. r b-/74
Size of Stone to be used: N 3 / depth or thickness i0
Atc-
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 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.
/0)--2-doee
gna ure of respon b e ers Date
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'v`ln rr en or observed, or `)elleve I saw evidence
all object houses, wells, trees, `en c.,
•
'" CUEEBBUP�Y shown on this docum I also r PKalt that I have
' r personally measured the set forth on the diagram."
BUILDING & DE EPT. 1
), -7-9c6"-
f EV+ c BY IGNi ,RE DAT
CC �j'l hs.ve seen or observed,or believe I saw evidence of,
`1�'fl 'ects such
c as houses,wails,trees,fences, etc.,
!Arm n this document, I also represent that I have
v 6 p) ,�so , ensured t a dist noes set forth on the diagram."
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SIGNATURE DATE
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TOWN OF QUEENSBURY
BUILDING &_CODE ENFORCEMENT 1 l '1
742 Bay Road -
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location � (05 Q
p
Date - Permi # a .` -5
SOIL TYPE: Sand-Loam-•.lay-
Resul is of Percol a ion t-
(if applicable) Ra e-Mi tell h
TYPE OF SYSTEM:
ABSORPTION FIELD: ot. L- •.th
Length of each tre 6.O
Depth of
Size of stone - /64,-�, 2-A
SEEPAGE PITS: Num.er-
Size - ft. ft.
Stone size
PIPING: e Type
Bldg. to Tank ysI
Tank to Dist. Box y" J Y
Dist. Box to Field/P. : �F" JJ
Openings Sealed? ' No Partial
LOCATION/SEPARATIO .
Foundation to Tank feet
Foundation to Absorptipn feet
Separation of Pits I feet
Conforms as per Plot Plan Y No
LOCATION OF SYSTEM ON PROPERT :
(circle one) --
Front - Rear - Right Side
Middle Front - 'ear
COMMENTS: /
4l /92i> f2/ /
SYSTEM USE APPROVED: NO 2.1
Arrived: /7-13�i
Departed:
VA/
Building Inspector
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•
eleivi rsits i 1 I.L(' 14 0 (
46V
' 0FE n/.S 60cl-y a' j .en or ahsery,d, or `.�plieve 1 saw evidence +
r houses, wt�ls,trees, ,e '
�,` ;. ;<<° � � ,{a all ablects su docum•- I also r : ent t�aor� have
iagram:.
,?r A ' .' 9 ' Shawn on this L • set
, BUILDING 84. DE
err: , � ," OF ( �„� 4+ personally measured ,
;w;
p . :`T' .PT• ,r,_ / .' ..--- nor
DEC o zoaoRE �Y - .. �,
h e seen or observed,or bel eve I saw evidence
a of,
-rOV; Or ?agISS CRY ,c"J l l eas such as houses,wells trees,nfenc d have
shnwn 4 n this document.l s ep set forth on the diagram"
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