2003-182 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: P20030182 Date Issued: Friday, April 18, 2003
This is to certify-that work requested to be done as-shown by Permit Number P20030182
has been completed.
Tax Map Number: 523400-308-012-0002-008-000-0000
Location: .47 NE NNESOTA Ave
Owner: FRANK &KATHRYN WHITING JR
Applicant: FRANK &KATHRYN WHITING JR
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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030182 Application Number: A26030182
Tax Map No: 523400-308-0.12-0002-008-000-0000
Permission is hereby granted to: FRANK & KATHRYN WHITING JR
For property located at: 47. N NNESOTA 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: FRANK ,& KATHRYN WHITING J
47 MINNESOTA Ave Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
r
Contractor or Builder's Name/Address Electrical Inspection Agency
SANTTARY SF,WF,R
DAN DRFLLOS
PO BOX 224
GUNS FALLS NY
r
Plans&Specifications
2003-182
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 17,2004
(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 Town of Que s btuv u ay,April 17,2003
SIGNED BY' d3 for the Town of
., Queensbury.
Director of Building&Code Enforcement
FILEL04,-02 '02 Aft 11 25;ID TOWN OF QUEENSBURY FAX:518.' 745 4437 PAGE 1
A.ppllcatiotx for-Periciait—Septio Disposal System,
Town,of Queensbu 142 Day Road Quennsbury,Nr 12804 (518) 761=8256���
1. OWNER INFORMATION. t ._ .
R Office Use
Location of installation: P.{uAie t r/�ni
File Pe_striit.No.
Tax Map No. / / v
Fee Paid S .
Owner's Name: � fI L.fN
....................................
Address: Lin
IN t n/ esd t � _ ...._.�. . .._
2. INSTALLER'S NAME /i! 9r Q!L PHONE.NO.
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply.4 of
bedrooms with applicable gallons per bedroom to equal total dailyflow)
Year of HoUsee No.of ftdro g x x r.2=utatiog .. Tota113ai1v Flow
1980 or older x 150 gallbdrm _
1980 '1991 x. ' 130 gaVbdrrri
1991 -present x 110 gaUbdrtn YJ
Garbage Grinder Installed - yes._. r no � APR 17 2003
Spa or Whirlpool.Installed. yes
TOWN OF:C)U,E'NSj3uRy
4. PARCEL INFORMATION: (circle.applicable biltbi msition dt indicate measurements) 119L
a at what depth at what depth unict
Meg jest•'' feet
Steep slope clay ("well;water supply
%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test:, (To be completed by licensed professional engineer or arphitecV : T
Rate: minute per inch
S. PROPOSED SYSTEM;-For New Congtruetion: All individual towage disposal systems must be desigwA-by a licensed'
professional engineer or architect(unless installed in a Planning Board approved subdivision). 'Add Z50 ' +
of the septic tack and leach field.fbr each Garbage ChIn ler,Spa or Whirl 1 Tub gallons to Wo size
Septic Tank: b CJI "gallon(min. size 1,000 gal.) � �
Tile Field: each trench ft. Tbtal System Length: f?
Seepage Pi#(s): number of size ofeaeh: - R bye?
Size of Stone to be used: # / depth or thickness feet
Bed System Size: = x
Alternative Systern: ' length and/or site
6. HOLDING•TANK SYSTEM: (if required)
Number of tanks: % Siz.0 of each: gallons /TOTAL Capacity: gallons
Note: Alarm Systerri and associated olettrieal"work must be inspected by a Town approved
electrical inspection agency.
7. SIONATURE dG INFORMATION FOR RESPONSIBLE PERSON(please read)
For your pi+vteotion,please•note that pursuant to Section 13 6-29 of the Code of the Town
of Queensbury;any permit or approval granted which is based upon or is grunted in
reliance upon any material misrepresentation or.'failure to make a material fhct or
circumstance known by or on behalf of an applicant, shall be void.
I have e" g4Iadons with sv ct to this application aril agree to abide by these and all
requir of 'e.'rown of Que' Sanitary wage Disposal Ordinance. -
Sip a re of respon_ 1 f* per on Oa
• Septic Inspection Report
Office No. (518)761-8256 Date Inspection requestreceived:
Queensbury Building&Code Enforcement Arrive: am/V D pao - 0 am/pm
742 Bay Rd., Queensbury,NY 1,2804 Inspector's Initials:
NAME: 4la — � �1 PER NO.: . yr V.-n
LOCATION: INSPECT ON: —L4 —
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water !
Waterline separation distance ft. Q
Well separation distance ft. �V, C n- 1-` � C
Other,wells: ft.
Absorption Field: Total length ft. Al L--
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Typei.
Building to tank E}
Tank to Distribution Box
Distribution'Box to Field/Pit _
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as er Plot Plan Y N
Location�System on Property:
rFro)nRear Left Side Right Side
Middle Front Middle Rear
System Use Stag
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:1SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
03-1
RECENED
APR 17 2003
1 TOWN OF QUEENSBURY
_BUILDING LAND CODE_
no /oOD
► i L Cl>t_Et�S`?tIRY 4G DEPtRTM
TlI��
eased on our limited examination,
compliance with our comments shall
not be construed as indicating the
plans and specifications are in full
ccmplianca�:�ith the Cade.
TOWN '01° C�U�wEN' ' y �y
BUILDING & S , T.
REVIEWED BY
DATE L ,
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
n this dacl#, P - also reoresent that I have
je7r,sona ly measured s-,ices set forth on the diagram."
I -710
SIGNATU E GATE