2002-543 71.111r:
TOWN OF QUEENSBURY
742 BayRoad, eensb NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20020543 Date Issued: Friday, February 01, 2008
This is to certify that work requested to be done as shown by Permit Number P20020543
has been completed.
Tax Map Number. 523400-227-017-0002-009-000-0000
Location: 104 SEELYE Rd
Owner. JAMES &NANCY WHITE
Applicant JAMES &NANCY WHITE
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
/// _—
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.
Ask TOWN OF QUEENSBURY
wi 4y 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020543 Application Number: A20020543
Tax Map No: 523400-227-017-0002-009-000-0000
•
Permission is hereby granted to: JAMF,S &NANCY WT-TTE
For property located at: 104 SEELYE 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. i Type of Construction Value
Owner Address: JAMES &NANCY WHITE
P.O. BOX 124 Septic Alteration Residential
Total Value
CLEVERDALE, NY 12820-0000
Contractor or Builder's Name /Address 'Electrical Inspection Agency
OUTEENSBTTRY SEWER
JAY SWEET
•
Plans&Specifications
• s BP 2002-543
Septic Alteration as per plot plan and specifications
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, June 27, 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 ensb T , s y, June 27, 2002
SIGNED BY ir 4 for the Town of Queensbury.
Director of Building& ode En'.rcement
Application for Permit Septic Disposal System f
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-82
duN 2 6 2002 aaa�—s `13
1. OWNER INFORMATION: - �
TowNo
Location of installation: e' �-E°P�I `4� ��c J` ;• E3UIL DING AND
C metBD�"°RY
File Permit No.
Tax Map No. / /
1 Fee Paid
Owner's Name: f t'Vl Gg
Address: /0 y f .e eef
2. INSTALLER'S NAME a , PHONE NO. _ ?6yr
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s)and multiply#., ..
bedrooms with,applicable gallons per bedroom to equal total daily fl g ut ECFIVPi
Year of House: .` . No.of Bedrooms x • Computation = Total Daily Flow JUN 2 6 2002
o .rr -- x 150 gal/bdrni = 7 I,®WN OF QUEENSBURY
':i -1991 x 130 gal/bdrm = EiU DING AND CODE
1991;—present x 110 gal/bdrm =
Garbage Grinder.Installed yes /44,,
Spa or Whirlpool Installed yes /
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water . Bedrock or Impervious Material Domestic Water Supply
sand ' at what depth at what depth municipal-
Rolling =a feet feet CP
Steep slope c ay if ivell;water supply
%slope other
depth: from any septic-s s�m
p absorption i ft.
other r-
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch Cv o
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:A) '-z)gallon-(min. size 1,000 gal.) ,
Tile Field: each trench ft. Total System Length: 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:
Alternative System= ( (Ty Clem_ length and/or size • i/ et.)
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.
,7 Z
Si tur of responsible person Date
Septic Inspection Report
Office No. (518) 761-8256 Date Inspectfon request received:
Queensbury Building&Code Enforcement Arrive: /(7,G5 am/ m Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 'OW
NAME: , 1 �- PERMIT,NO.:
LOCATION: /04 ; cv_ ` INSPECT ON: 3 L►s
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water
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
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank / �ef�i
Tank to Distribution Box
Distribution Box to Field/ Pit
C/05e- uv
Opening Sealed: Y/ N/ Partial
End Cap
Inlet/Outlet Pipes&Baffles Y N
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Usettus:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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"I have seen or observed, or believe I saw evidence of, L._
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all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have i rti
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personally measured e distances set forth on the diagram." 1 �_
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SIGNATURE DATE