2000-252 Certificateof Compliance
Town of Queensbury
Warren County,New York
Date May 1 2 0.0 U �
This is to certify that work requested to be done as shown by Permit No. TM_ `
52
has been completed.
This structure maybe used as a__ — SEPTIC ALTERATION
Location 152_SUNNYSIDE EAST
Owner
TAX MAP NO. 5 4 . -1-3 E B Order Town Boar
�T/ O. U
Director of Building&Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 2000252
TAX MAP NO. 54 . -1-36
HOPKINS, STACEY A.
Permission is hereby granted to
Owner of property located at 152 S UNNY S IDE EAST
in the Town of Queensbury,to construct or place a SEPTIC ALTERATION
at the above location in accordance to 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.
Owner's Address:
152 SUNNYSIDE EAST
QUEENSBURY, NY 12804
Contractor or Builder's Name:
O`CONNELL PLUMBING & HEATING
Contractor or Builder's Address:
Electrical Inspection Agency:
COMMONWEALTH ELECTRICAL AGENCY
PO BOX 706
HAGUE, NY 12836
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
25 May 1 2002
$ PERMIT FEE PAID—THIS PERIVIIT EXPIRES
(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.)
1 May 2000
Dated at the To Queensbury this I Day of
SIGNED BY for the Town of Queensbury
Code Snforcement Officer
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit NO.
Building &Codes Office
742 Bay Road Fee Paid $ i
Queensbury, NY 12804
Location of property for installation: ` �� Jul Ws( o; ��5
Property Owner's Name: f -r C f V L ® K) ru S
Property Owners Mailing Address: W 1'tl��t-S-'=�d�4 �S 1 J
Installer's Name: 0,61 00 tutu Q �U r7t rty q c� �f ne # 7 L13 —L
Number of bedrooms (if residential): T Total daily flow: 06
(residential - compute @ 150 Qal./bdrm.)
Topography: flat, rolling, steep slope of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth?/A feet / Bedrock or Impervious Material: at what depth. feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: municipal, —)(- well, other /
If domestic water supply is a WELL, water supply from any septic absorption feat.
PROPOSED SYSTEM
Septic tank: )-00a gallon (minimum size: 1,000 sal.)
Tile field: each trench—ev--feet / Total system length: ;X0
I-A* feet
J
Seepage pit(s): number of / size each: . ft. by ft.
Size of stone to be used: # � I depth or thickness _�feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each- aaIlons
Alarm system azyd associated electrical work to be inspected by a certified agency.
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 misrepresn or failure to make a
material fact or circumstance known by or on behalf of an applicsgt, 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
Signature of responsible person. Date: �l/v
—�' TOWN OF QUEENSBUR
BUILDING _& CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12864
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 's
Location
Date Permit # �
SOIL E• and Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Min a/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To al Leng h
Length of each tren h
Depth of. trenches
Size of stone
SEEPAGE T�j 4NUM r-_
Size - t.
Stone size
PIPING: size Type
Bldg. to Tanker
Tank to Dist. B x
Dist. Box to Fi el d/Pi-t � v`
Openings Seale ? Ye No Partial
LOCATION/SEPAP TION .
Foundation to Tank. feet
Foundation to Absorption --r feet I,.
Separation oi' Pits feet
Conforms as per Plot Plan a No
LOCATION OF SYSTEM ON ITER(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
f 6 A-t- • T,v K . � - g X
4-6
SYSTEM.USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector
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seen-or ot-served, or believe I saw evidence of,
_ all objects such as houses, wells, trees,'fences, etc.,
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shown on this document. I also represent than l have . _______ • ,-: - _
kpe;� easur ist forth on;the diagram." r
2000252 . ' '54': =1-36
HOPKINS, STACEY, A. "
152 SUNNY SIDE,.EAST
SIGNATURE DATE SBpTIC.:ALTERATION: ;