2003-406 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: P20030406 Date Issued: Thursday,,June 12,2003
This is to certify that work requested to be done as shown by,Permit Number P20030406
has been completed.
Tax Map Number:, 523400-301-013'.0001-062-000-0000
Location: 7 IROQUOIS Dr
Owner: BART&MAR.YANN JOHNSON
Applicant: BART&MARYANN JOHNSON
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBCJRY
Director of Building&Code n£orcem nt
TOWN OF QUEEN SB►URY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030406 Application Number: A20030406
Tax Map No: 523400-301-013-0001-062-000-0000
Permission is hereby granted to: BART&MARYANN JOHNSON
For property located at: 7 IROQUOIS Dr
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: BART&MAR.YANN JOHNSON
7 IROQUOIS Dr Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
I.R.S. SEPTIC
2 LOWER WARREN STREET
Oi 1F,F,NSB JRY.NY
Plans&Specifications
2003-406
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 Queensbury before the expiration date.)
Dated at the Tf dnesday,June 11,2003
Quee bu ; //W
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: Office Use.
Tax Map No. File Permit NO.
O ks, C�10
Owner's Name: Z�tx 7- -J-e Fee Paid
Ad dress:
.2. INSTALLER'S NAME PHONE NO.
.3. RESIDENCE INFORMATION: (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 Computation = Total Daily Flow
1980 or older x 150 gal/bdrin =
1980- 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrin =
Garbage Grinder Installed yes no 'K-
Spa or Hot Tub Installed yes no
4.* PARCEL INFORMATION: (circle applicable information&indicate measurements)
T o �ahh Soff-W attire.- Ground Water Bedrock or hWervious Material Domestic Water Supply
la n at what depth atA�ptth municipal
k- -feet f
R61iing oam f e, well
'Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed b.y 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: !0,90 gallon (min. size 1,000 gal.)
Tile Field: each trench 5,1) ft. Total System Length: 00
'A
Seepage Pit(s): number of : size of each: _ft. by_ft.
Size of Stone to be used: # depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons 1 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 n 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.
409 Signature-of�responsible�person Date
- Septic Inspection Report
Office No. (51'8)'761-8256 Date Inspectiorq �qfi ItQueensbury Building&Code Enforcement Arrive: rt: aml
742BayRd.,QueensburyNY 1,2804 Inspector's IniNAME: S fr>�G � �`'LOCATION: �'lio�S
RECHECK:
Comments and/or diagram
Soil Type: and' Loam 1 Clay
Type of Water, unieipa Well Water
t
Waterline se aration is ance ft.
Well separation-distance ft.
Other.wells: ft.
Absorption Field: Total length ft. �
Length of each trench olhvt.
Depth of trenches -, ft.
Size of Stone T; de,�
Seepage Pits: Number
Size: x
Stone Size: ��
Piping Size iT " e
Building to tank::
Tank to Distribution Box
Distribution Box t ield 1 Pit %I Ul
Opening Seale artial
Location 1 Separations
Foundation to tank
Foundation to absorption _ ft.
Separation of Pits
Conforms as per Plot Plan N-
Location of System on Property: r
Front Rear Left Side Right Side
Middle Front Mi dle Rear
System Use Stat
. Approved
^Partial Approved and needs to be re-inspected,please call the Building&Codes Office
•Disapproved
L:1SueHen ingway\Bui]ding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
► _
.11 have seen or observed
s����� .
all objects such or believe 1 saw °"�
show'*' on as houses, wiells trees evidence of, J(/A
this d°cu'i�ent. I 4f Fences, etc., - 1
personall measured the also represent that 1 ZOd3
distances set forth have BU°®�FQ�}�.
°n the diagram." N�, ����U
- � D�o®F y
SIGNATURE
DATE
REVIEWED BY
TOWN-OF QU ENSBURY BUILDING DEPARTMENT
Based on our limited examination,
compplia ice with our comments shall
not be rtstrued as indicating the
plans d specifications are in full
compli ce Mth the Building Codes y,
of New ark State.
f V ✓.
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