2004-341 11111r—
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: P20040341 Date Issued: Monday, May 24, 2004
This is to certify that work requested to be done as shown by Permit Number P20040341
has been.completed.._ _. .
Tax Map Number: 523400-309-010-0001-032-000-0000 0
Location: 93 MAIN. St
Owner: RICHARD KERCHNER
Applicant: RICHARD KERCHNER
This structure may be occupied CIA PIRRONE
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(7/)J
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
re:0
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040341 Application Number: A20040341
Tax Map No: 523400-309-010-0001-032-000-0000
Permission is hereby granted to: RTCHARD TKFRCHNF,R
FET,TCTA PIRRONE,
For property located at: 93 MAIN 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. + Type of Construction Value
Owner Address: RICHARD KERCHNER
FELICIA PIRRONE - Septic Alteration Residential
Total Value
93 MAIN St
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical.Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OT TEENSBI TRY. NY
Plans&Specifications
2004-341
SEPTIC ALTERATION
.^ J
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,May 24, 2005
(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 th Town Qu-,.j !,sb I%° �.�,:y, May 24,2004
SIGNED BY \ 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: 4-93 ( e {I
File Permit No. /
Tax Map No. / / cl)i v\-- Q
Fee Paid
Owner's Name: F—C.--C(r-CG r rror.._
Address: t9) J"i-c.4,./Vl7 'PT
2. INSTALLER'S NAME : . � 6 � 5-cp?) PHONE NO. 2Yr ,E(7C
57
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) 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
) �
1980 or older x 150 gal/bdrm = �
1980— 1991 x 130 gal/bdrm =
1991 —present - . x 110 gal/bdrm =
Garbage Grinder Installed yes` / no
Spa or Whirlpool Installed yes— / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
• raphy : S ' ature Ground Water Bedrock or Impervious Material D 'dater Supply
sand at)vja depth at wha depth unici al
Rolling m feet feet
Steep slope clay if 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: 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: 70C9'd gallon (min. size 1,000 gal) �[��'\ /�i jyrl7 (�`�\
R E`� �Fl tJ `+�
Tile Field: each trench 50 ft. Total System Length: ft.
MAY 2 0 2004
Seepage Pit(s): number of size of each: ft by- ft.
TOWN OF QUEENSBURY
Size of Stone to be used: # / depth or thickness feet BUILDING AND CODE
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.
5fo
h /dOe
Sig ature of responsible person Date
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No. Cert. No 7 8 0 91 Cut-in Card No.
Owner i3 .b G......._.:
Location 1.0 / .4n1..t ....1- �'t— Q...v..ternJ 64,
Ay
Installation Consisting of / -.z1.@
.3.mA aa.l mi.k.i2:117,
Installed By .Axn Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making inspections at any time, and if its
rules are violated,the Company shall have the right to revoke this certificate.
Date 7- y INSPECTOR.., ...............
M.....�.-.AT VD A l A F l
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received: 4.7 b�
Queensbury Building& Code Enforcement Arrive: am/ epart: - in/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: yv('r Ke/1'`A '✓ PERMIT NO.: 04 3 l /
LOCATION: g3cu,yNQ- INSPECT ON: �1C11.—r /.
RECHECK: Se-,��,' /
c-
Comments and/or diagram
Soil Type: Sa ay
Type of Wate : Munici ell Water
Waterline separation distance _ ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length - ) ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone j i, .t LTAATO 2 Ijy S .
Seepage Pits: Number
Size: _ x
•
Stone Size:
Piping Si;,,, Tye
Building to tank 'Ag. 3 S.'.--'
Tank to Distributio ox it u
Distribution Box o eld/Pit it ti
Opening Sealed. Y N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits f ft.
Conforms as per Plot Plan 1/Y N
Location of System on Property:
Front i' -. Left Side Right Side
Middle Fro Middle Rear
System Use Sta s:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
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compliance with our comments shall
not.be construed as indicating the
p nd specifications are in full
compl�nce with the Building Codes
of Nev York State,
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