2003-365 (2) TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256 .
BUILDING PERMIT
Permit Number: P2.0030365 Application Number: A20030365
Tax Map No: 523400-288-000-0001-018-001-0000
Permission is hereby granted to: PF,TF,R &MAT JRF,F,N STF.CTT JK
For property located at: GURNEY Ln
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 ofConstruction Value
Owner Address: PETER&MAUREEN STECIUK
32 KINGS MILL Rd Septic Alteration Residential
Total Value
GANSVOORT,NY 12831-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
FTJT,LF.R F,XCAVATION
NY 12804-0000
Plans&Specifications
2003-365
SEPTIC ALTERATION AS PER-PLOT PLAN SPECIFICATIONS
$25,00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday;June 11,2004
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queenshury before the expiration date.)
Dated at the To n of ensb d sday,June 11,2003
SIGNED BY { for the Town of Queensbu
ry.
Director of Building&Code Enforcement
4 Application for Permit Septic Disposal System
.Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256C9"0
1. OWNER INFORMATION:
........................................_............................._.......................................................,
= Office Use
Location of installation: 3 ?! �t '
File Permit No.
Tax Map No. 2 Y?
Fee Paid
Owner's Name'--L17a «c j�'� Y- _ ;
..................._........ :..........._..............................
i�9�tY— ......... ..........._.
Address: 3 Z ktt,16! - /tilt!/ ,�� 2003
Fuller Excavation TQU/pIV,EENSBURY
2. INSTALLER'S NAME Box 136 Hicks Rd. PHONE N ND CODS
Granville,.
NY 121$3 3. RESIDENCE INFORMATION: (circle year 048)IW SZQ6te#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 3 x 110 gal/bdrm = '
Garbage Grinder Installed yes_ / no
Spa or Hot Tub Installed yes_ / no _
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
TopoQranhy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat sand at what depth at what depth municipal
Rolling loam eV,617L feet 4/6a�,p feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth:�rr cl f absorption is ISo ft.
other uv.p//
Percolation Test: (To be.completed by-licensed professional engineer-or ar_ch_itet)c .T
Rate: ;� minute per inch (1 ��,v'el e',re I/P�
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: 1250 gallon(min:size 1,000 gal.)
Tile Field: each trench ft. Total System Length:
Seepage Pit(s): number of a -size size of each: _29a-6ft. by -AV
Size of Stone to be used: #` 3 / depth or thickness J r feet
Bed System Size: x
Alternative System: length andlor size
6. HOLDING TANK.SYSTEM: (fir)
Number of tanks: /c750 1 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.
Signature of responsible person . Date
..I�U�v tt •0i i.�t.T{i{�Z.1.�t�1'tt t•x -
Scs�vc:t•:1 ;1110 Sewi%ge Dist msal tlizsttsir:•
.1�It1�t�tttli:c t: _
A'U.;()Ri'•'•1'1t N..
SPA" \•1t11TIO N it (,11,11110D.1It:N'1`-i
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_ Ibua� � �� � to 11 »sue. G • � � 1
� � -••" ..__ Lam"
7At fY�
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7. SIQNATURE 8Z ICIFORMATIS:?3`t FOIL k �Yut`d )1Csi. irsr vim�yacm..••••••:;
Septic Inspection Report
Office No. (518)761-8256 Date Inspection rVreNcQueensbury Building&Code Enforcement Arrive: : -` a m742 Bay Rd.,Queensbury,NY 12804 Inspector's Initia
NAME: r��� 1 I P �.-1` ~- U
LOCATION: r INSPECT ON: 23 0-3-
RECHECK:
' ��omments andlar diagram
Soil T e: Sand/Loam/Clay
Type of Water: Municipal/Well Water v
Waterline separation distance ft. '1D
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft. Di
Len of each trench ft. D` t
Depth of trenches - - ft. �
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank VVIN tA b ON ,'1>
Tank to u `o x
Dig� o Field Pit TffLl
ening Sealed: Y
Location/Separations / 1—p
Foundation to tank-
Foundation to absorption ft.
Separation of Pits
Conforms as per Plot Plan Y N
Location of System on Property
Front Rear 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
Septic Inspection Report
Office No. (518)761-8256 Date 1nsP!cti0,4,reque
� �kc ived:
Queensbury Building&Code Enforcement Arrive: P) a��Oxart:
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials.
NAME: PERMIT NO.:
LOCATION: INSPECT ON: Z3.
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance
Well separation distance ft.
Other wells: �ft.
Absorption Field: Total length ft.
Len of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: ' x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y/N/Partial
Location/Separations z
Foundation to tank A
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan /Y N
e Location of System on Property.
Front Rear Left Si e Right Side
Middle Front M'Idle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Eli Disapproved
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RECEIVED
TOWN OF QUEENSBURY BUILDING DEPARTMENT
i
Based on our limited examination MAY 3 0 2003
can�qI�ance with our comments shall TOWN
not be construed as indicating the OF QUEENSBURY
plans and specifications are in full BUILDING ANp
rbmpliance with the Building Codes
of New York State. i
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BUILDI4B2
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REVIEWE
DATE