Loading...
2004-261 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: P20040261 Date Issued: Tuesday, May 04, 2004 This is to certify that work requested to be done as shown by Permit Number P20040261 has been completed. Tax Map Number: 523400-295-019-0001-047-000-0000 Location: 3 PINEWOOD Ave Owner: DAVID & JANICE CASEY Applicant: DAVID &JANICE CASEY This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY (", )i W A-- Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040261 Application Number: A20040261 Tax Map No: 523400-295-019-0001-047-000-0000 Permission is hereby granted to: DAVID &JANTCR C;ASEY For property located at: 3 PINEWOOD 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. Type of Construction Value Owner Address: DAVID & JANICE CASEY 3 PINEWOOD Ave Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-261 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, May 04, 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 T f7ztW 4t!! ay 04, 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: Location of installation:` P//��(rl�-� L M Office Use �— File Permit No. 1 Tax Map No: / / r ,Owner's Fee Paid' Name: U7 ' G� 1_._.,.. _..._......_....._......�......___�___._....-_.._.._.....__. Address: 2. INSTA-LLER'S NAME : W! :7Vt, - PHONE NO. Z -7_-73'7 3. RESIDENCE INF'ORMATI;ON: (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' CEQ putatiori — Total Daily Flov� 1980 or older x 150 gal/bdnn = � 1980—1991 x 130 gal/bdrm 1991 —present x 110 gal/bdrm Garbage Cninder Installed yes` / no f ����� Spa or Plot Tub installed yes` / no Qj'� 4. PARCEt NFORMA,TIONi (circle applicable information 8t indicate measurements) 'i4�", cf' To o d cic or I ervi D ©�G41'Wa u ] 1 a at what depth at what depth uni i Rolling loam feet feet Steep slope clay 'Jf well;water-supply _°o slope other from any septic-system depth: absorption is fr. other Percolation Test:, (To be completed by licensed professional engineer or architect) . Rate: minute per inch 5. PROPOSED SYSTEM k'or New Constructign: 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: 1 gallon (min..stze 1,00O gal) Tile Field: each trench ft. Total System Length: ft. Seepage Fit(s) number,p /b' size of each: ft, by ft. Size pf Stone to be,used: # / depth or thickness feet Bed System Size: x Alternative System;_r 1,Ce V length and/or siz, 1,5')d 2,0 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.Towti approved electrical inspection agency. 7. SIGNATURE-"&INFORIdI&TION FOR RESPONSIBLE PERSON(please road) 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 wi ect to this application and agree to abide b' y these and all require f the Town of Q ens Sanitary Sewage Disposal Ordinance. 3 . ig ature of respon i e person Da e T00/T001n Xva.. ££:CT M1 £OOZ/TO/LO Septic Inspection Report Office No. (518) 761-8256 Date Inspection request ceiv Queensbury Building&Code Enforcement Arrive: am/ rt: am 742 Bay Rd., Queensbury,NY\ 1,2804 Inspector's Initials: .. NAME: ,` i 1 P J IT NO.: ®�J�1 LOCATION SPECT ON: L�f RECHECK: Comments and/or diagram Soil TYPV San oam Clay Type of ivatoq Well Water Waterline separ_a—t1-'oKz15tance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length �--�- Length of each trench ft. Depth of trenches ft. Size of Stone rs_ See a e Pits: Number Size: x Stone Size: Piping Size Type Building to tank r , Tank to Distribution Box Distribution Box t field/Pit O ening Sealed• Y Partial Location/Separations Foundation to tank 0 ft. Foundation to absorption r Separation of Pits Z ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Sid �Side ' Middle Fr n iddle Rear System Use St us: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\Building.Codes.Inspection.FORMS1Septic Inspection Report.doc January 28,2003 r Y 4� D -� _ n m Cm E; o 01 v z O r rn m � r "I have seen or observed, or believe 1 saw evidence of, all obiects such.as houses, wells, trees, fences, etc., shown cn this document: I also represent that I have perso measured. the.distances set forth on the diagram." S"- 3-o/ SIGNATURE DATE