2001-812 TOWN OF QUEENSBURY
r 742 BayRoad,Queensbury, 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010812 Date Issued: Wednesday, October 31, 2001
This is to certify that work requested to be done as shown by Permit Number P20010812
has been completed.
Tax Map Number: 523400-289-018-0001-025-000-0000
Location: 35 FITZGERALD Rd
Owner: DALE & FLORENCE JARVIS
Applicant: DALE & FLORENCE JARVIS
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
("DJe•
Director of Building&Code Enforcement
1
� ` TOWN OF QUEENSBURY
Fivo 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010812 Application Number: A20010812
Tax Map No: 523400-289-018-0001-025-000-0000
Permission is hereby granted to: DALE& FLORENCE JARVIS
For property located at: 35 FITZGERALD 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: DALE & FLORENCE JARVIS Septic Alteration Residential
13 HARBOR COVE Ct Total Value
DAYTONA BEACH, FL 32119
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans & Specifications
2001-812
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday, October 30,2002
(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 T of Que sbury; Tuesday, October 30,2001
SIGNED BY4 for the Town of Queensbury.
Director of Buil & e Enforcement
Application for Permit—Septic Disposal System
Town of Oueensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
5 id Office Use
Location of installation: ► gy,..
I_' f L'C� � File Permit No / T
Tax Map No. 'T / / / / / CoI Fee PaidS-
Owner's Name. \.LL ` AAJc5
Address:
2. INSTALLER'S NAMECPue YI U C PHONE NO. F/V E D
(circleyear of dwelling, #bedroom(s) and multiply# of
3. RESIDENCE INFORMATION g
bedrooms with applicable gallons per bedroom to equal total daily flow)OCT 3 0 2001
Year of House: No. of Bedrooms x Computation = Total Daily Flow70WN OF QUEENSBURY
BUILDING AND CODE
ge- ...3 x 150 gal/bdrm = ��
1980- 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes_ /6
Spa or Whirlpool Installed yes /cr r
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
la san at what depth at what depth municipal /'
Rolling loam feet feet 4
Steep slope clay if well; water supply
__%slope other from any septic-s stem
depth: absorption is' t.
other `'..p_L
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:c ' C)gallon (min. size 1.000 gal.)
Tile Field: each trench ft. Total System Length: 6' ft.
Seepage Pit(s): number of size of each: ft by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: /9 x e
Alternative System:LJ Q. ik..) length and/or size 7-'-' _ .2 S'
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 anitary Sewage Disposal Ordinance.
_� QGr' `?D —6)Sign of responsible person Date
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name h
Location F<<'z t�Ao o gAn
Date 1 b���—a` Pe it # 2..c t
SOIL TYPE: Sand-►oa 0 ay-
Results of Percolation Test-
(if applicable) Rate-M'nute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To . 1 Length S(ip
Length of each trenc
Depth of trenches Z! — 3 '
Size of stone CO ., -rr Sc 3I)
SEEPAGE PITS: ber-
Size - ft. x ft.
Stone size
PIPING: 'ize Type
Bldg. Tank ,N'` '`
ww
Tank to to Dist. Box 141 P"JC h
Dist. Box to Field/Pit _ ." , c_ —
Openings Sealed? artial
LOCATION/SEPARATI .
Foundation to Tank ; feet
Foundation to Absorption A4feet
Separation of Pits feet
Conforms as per Plot Plan Yes_,e
LOCATION OF SYSTEM ON PROPER
(circle one)
Front 'ear a Left Side - Ri•ht Side
Middle - "'..' ' .
COMMENTS:
SYSTEM USE APPROVED: YES
Arrived: Pe
Depar
ing ns e