2005-312 TOWN OF QUEENSBURY
742 Bay Road, Queensburv,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050312 Date Issued: Tuesday, May 24, 2005
This is to certify that work requested to be done as shown by Permit Number P20050312
has been completed.
Tax Map Number: 523400-308-012-0002-037-000-0000
Location: 60 WISCONSIN Ave
Owner: EDNA WINSLOW L.E.
Applicant: EDNA WINSLOW L.E.
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (—�Dj
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050312 Application Number: A20050312
Tax Map No: 523400-308-012-0002-037-000-0000
Permission is hereby granted to: F.DNA WINSLOW I,F,.
For property located at: 60 WISCONSIN Ave
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. Tyne of Construction Value
Owner Address: EDNA WINSLOW L.E. Septic Alteration Residential
JOHN& LINDA WINSLOW Total Value
60 WISCONSIN Ave
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name / Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2005-312
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, May 12, 2006
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queenshury before the expiration date.)
Dated at the To ueensb ; Th rsday, May 12, 2005
SIGNED BY 0for the Town of Queensbury.
Director of Building ode forcemeat
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:
File Permit No.
Tax Map No.
�� � ; Fee Paid �,��� All
Owner's Name: r aj
r ........................................................................................................................................
Address: 0 &1
2. INSTALLER'S NAME PHONE NO. 7L2- 7.,2,5 �
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 Z- x 150 gal/bdrm =
1980- 1991 x 130 gandrm =
1991 -present x 110 gallbdrm =
Garbage Grinder Installed yes. 1 no
Spa or Hot Tub Installed yes^ ! no!/ // •�� ' _
3�
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
IMIWaphyS e Ground Water Bedrock or Izn ervious Material . Domestic Water Supply
FI sand at what depth at what depth municipal
ling 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: I Q gallon (min. size 1,000 gal)
Tile Field: each trench l 2-- ft. Total System Length: /0��v ft. RECEIVED
:%47
- size o each: t, b t.
Seepage Pit(s): number off f y f
Size of Stone to be used: # depth or thickness feet
TOWN OF QUEENSBURY
Bed System Size: �JTA
Alternative System: !. ( x BUILDING AND CODE
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 f the Town of Qu bury Sanitary Se age Disposal Ordinance.
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7. SIGNATURE &INFORMATION POF USt ucuy'wLz rzx%.ovi4 Waon..,
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Septic Inspection Report
Office No.(518)761-8256 Date Inspection re est cei d:
Queensbury Building&Code Enforcement Arrive: xn/p epart: O`,.
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initia
r
NAME: �,� 1 t\l�itp >> EgMIT NO.: pp. — BIZ
LOCATION: �ll� s��11 z��� p��}E IN PECT ON:
RECHECK:
Comments and/or diasram
Soil T : San / am/ a
T e of ater. ici al ell Water
Waterline s a lion I ce ft.
Well separation dls ance ft.
Other wells: $.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches 2 ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size TVDe
Building to tank
Tank to Distribution Box
Distribution Box ie d/Pit �► Q�c�����.
Opening SealeK Y/ /Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
SSparation of Pits ft.
Conforms as per Plot Plan Y N
Location of System on Property:
Front Rear Left Side ght Sid
Middle F nt Middle Rea
System Use S tus•
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
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TOWN OF QUEENSBURY BUILDING DEPARTMENT
Based on our limited examination,
comppliance with our comments shall
not be construed as indicating the
plans and specifications are in full
compliance with the Building Codes
of hlew York State.
BUILDING& D T.
REVIEWED BY `
DATE Q
RECEIVED
MAY
TOWN OF QLIEENSBURY
BUILDING AND CODE