2002-763 Ma TOWN OF QUEENSBURY
OM 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
Q �Y
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20020763 Date Issued: Friday, September 13, 2002
This is to certify that work requested to be done as shown by Permit Number P20020763
has been completed.
Tax Map Number: 523400-289-007-0001-028-000-0000
Location: 28 REARDON Rd
Owner: PATRICK & CHRISTINE SEELYE
Applicant: PATRICK & CHRISTINE SEELYE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
B / /
Mi r
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
A 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
S,
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020763 Application Number: A20020763
Tax Map No: 523400-289-007-0001-028-000-0000
Permission is hereby granted to: PATRICK & CHRISTINE SEELYE
For property located at: 28 REARDON 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: PATRICK& CHRISTINE SEELYE
28 REARDON Rd Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
JAY SWEET
NY 12804-0000
Plans&Specifications
2002-763
Residential septic alteration per plot plan and specifications.
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, September 13,2003
(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 To o ueens d,4 , September 13,2002 l '
SIGNED BY for the Town of Queensbury. i E `
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensburyy,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Location of installation: , if' Office Use
Tax Ma No. / / File Permit No. �0Z 7 /
P
I-4 '•
f / � Fee PaidOwner's Name: ? 'c Cl� � � Yf V�j� ' ........_...._..»........_._ I
Address:
2. INSTALLER'S NAME : \E_F iJSC,y� 5EI W ?._ PHONE NO.7 Z--�(049
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 = IAD _
1991 —present x 110 gal/bdnm =
Garbage Grinder Installed yes /
Spa or Whirlpool Installed yes_ / i
4; PARCEL INFORMATION: (circle applicable information&indicate measurements)
CTO�ranhv Soil-Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
at what depth - at what depth municipal
Rolling loam feet _' feet (P)'
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is YO ft.
other V Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch W?---
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: /O—� gallon (min. size 1,000 gal.) 1��E17 %v7 Dom%1
Tile Field: each trench 2-T) ft Total System Length: to 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: _1 0 x /0
Alternative System: i LSS le t3 length and/or size 3 o `F /
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.
22/ - �. � q).., /U -
Sln ur of responsible person Date
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCE 3,
742 Bay Road
Queensbury NY 12: $ '
(518) 761-8256
SEPTIC DISPOSAL SYST INSP ,i
Name ,<E lWt.
Location 2? e E i-m, ,, ( L A )
Date ick—13—,z Permit # ► .Z—IC5
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Tes -
(if applicable) Rate-Minu 'e/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total ength ` (o
Length of each trench Z ZF '
Depth of trenches ► _ I
Size of stone ., -41011315, r _ \
SEEPAGE PITS: Number s5Yj
Size - ft. x / ft.
Stone size
PIPING: / Size Type
? Bldg. to Tank r '+ -hh
\)‘Q to Dist. Box ;
cC( Di st. Box to Field/,fit 9. 41 ce
Openings Sealed? Yes No Fa 1
LOCATION/SEPARATIS:
Foundation to Tan feet
Absorption eet
Separation of Pits _ f e
Conforms as per Plot Plan e o
LOCATION OF SYSTEM ON PROPERT
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS: bQ%%,‘\.`‘)
7LEL E� l
SYSTEM USE APPROVED: YE NO
Arrived: =
Depart
ti
uil g nspe for
r
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nave seen or observed, or believe I saw evidence of, .1444C'
I objects such as houses, wells, trees, fences, etc., E
?awn on this document. I also represent that I have.
rsonally measured the Oistances s t forth on the Bias
Ste i 0 Z002. •
lib
o ``- -f = 1 /Goo ikft* t`
Si NA B URE DATE �P-L. , ,i , EPARTM Nt
it or it •-tsfl1Jr aiion,
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s , Ce With cur comments shall
r.:i:Y construed as indicating the•
i _� „___` €�'r='�s specificationsand are in Nil
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