2004-060 - 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: _ P20040060,__. Date Issued: Friday, February 27, 2004
-_This-is=to.cer-tify that work requeste&to be done as shown by Permit Number P20040060
has been completed. -
Tax Map Number: 523400-295-015-0001-035-000-0000
Location: 6 CRESTWOOD Dr
Owner: ALEXANDER&JEAN FRANK L.E.
Applicant: ALEXANDER&JEAN FRANK L.E.
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
Lod 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040060 Application Number: A20040060
Tax Map No: 523400-295-015-0001-035-000-0000 .
Permission is hereby granted to: AT,F,XANT)F,R &TF,AN FRANK I,.F,.
For property located at: 6 CRESTWOOD Dr
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 widi the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: ALEXANDER& JEAN FRANK L.E.
KAREN PALMUNEN, LINDA HOW Septic Alteration Residential
Total Value
DIANA SWINTON
6 CRESTWOOD Dr
OUEENSBURY. NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OITEENSBTTRY_ NY
Plans&Specifications
2004-060
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS.PERMIT EXPIRES: Sunday, February 27, 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 the� n Quee7 g�-.�,, ebruary 27, 2004
�' for the Town ofQueensbury.
SIGNE)I3Y
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:
File Permit No. O N—06P 0
Tax Map No.
Fee Paid
Owner's Name: l. C'kVLn-c��l, /<—rot Ay E.......................................................................................................................................
Address: 0 �/`� � 6,06 J
2. INSTALLER'S NAME1 ��. S�/�l�C PHONE NO.
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 Zr— 1, j
Spa or Hot Tub Installed yes^ ./ now
4.' PARCEL INFORMATION: (circle applicable information&indicate measurements)
TOw��F 0
Tee�aDhv SDaNattire Ground Water Bedrock or Impervious Material ater Su l
at san atX h�t depth at Mwhaepth municipal
ing loam 1,"S feet et
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: 0 is gallon (min. size 1,000 gal)
Tile Field: each trench S6 ft. Total System Length:Pn) 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: 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.
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received: r
Queensbury Building&Code Enforcement Arrive: am/p e ` am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: ka). Q� P IPERMIT NO.:
LOCATION: h INSPECT ON: 7— ULl
RECHECK:
Comments and/or diagram
Soil Type S lay _
Type of Water: /Well�IWateE
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 L D
Seepage Pits: Number
Size: x
Stone Size-
Piping SizerTeBuildin to tank
Tank to Distributi i Box Distribution Box field J Pit
Opening Sealed. 'Y/ /Partial
Location/Separations
Foundation to tank ft•
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan N
Location of Syst on Property:
Front Re Left Side Right Side
Middle Front Middle Rear
System Use Status;-,"'
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
LASueHemingway\Building.Codes.[nspection.FORMS\Septic Inspection Report.doc January 28,2003
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