2003-464 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERT IFICATE OF COMPLIANCE
Permit Number: P20030464 Date Issued; ,Wednesday,June 2592003
This is to certify that work requested to be done as shown by Permit Number P20030464
Tax Map Number: 523400-296.014-0001-015-000-0000
Location: 37 SWEET Rd
Owner: MICHAEL SMITH
Applicant: MICHAEL SMITH
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: P20030464 Application,Number: A20030464
Tax Map No: 523400-296-0'14-0001-015-000-0000
Permission is hereby granted to: MICHAEL SMITH
For property located at: 37 SWEET 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. Type of Construction Value
Owner Address: MIC 3AEL SMITH Septic Alteration Residential
PAMELA BENACK Total Value
37 SWEET Rd
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans&Specifications
2003-464
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,June 24,2004
(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 th Town Qu sy; y,June 24,2003
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:
**-'---Ilse--*---**---
Location of installation: Office
File Permit No(22?�J__"� &
Tax Map No.
_F
Owner's Name
Fee 12 yyt L
Paid
............................................................................................... ..........
Address: -7 C.--.) --I
2. INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s)'and multiply#of
ip
bedrooms with applicablegaZlons per bedi-oom to equal total dallyflow)
Year of House: No. of Bedrooms x CgmPutation,= Total Daily Flow
.2= x 150 gal/bdrm
1980- 1991 x 130 gal/bdrm
1991 —present x 110 gal/bdrm
Garbage Grinder Installed yes— JUN'2'4 ,2003
Spa or Hot Tub Installed yes— cffb 'roBUILDIN
VVN Olz GQUeiEIVSJ3Uny
4.* PARCEL INFORMATION: (circle applicable information&indicate measurements). COpE
ToDoaraoliv ... Soil Nature Ground Water Bedrock or Impervious Material Domestic.Water Supply
<?�E6 �' at what depth at what depth o�i—unz �
Rolling loam —feet feet well
Steep slope clay
if
9-05 slope other well; water supply
depth: from any Septic-system
absorption is�ft.
Percolation Test: (To be completed by licensed professional engineer or t)architec other
Rate: minute per inch.
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: /-.2 gallon (min. size 1,000 gal.)
Tile Field: each trench ft, Total System'Length: ft.
Seepage Pit(s): number size of each: �ft by K'_ ft.
Size of Stone to be used: # f depth or thickness feet
Bed System Size: x
Alternaiiv6'System: length and/or size
6. .HOLDING TANK SYSTEM: (if required)
Number of tanks: gallons
Size of each: TOTkL Capacity:
gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electribal.iiispection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE_PERSON(pli�ise-`read)_
For your protection,please n6te:that pursuant to Section 136=29*ofthe-C6dd-of the Town
of Queensbury, any permit or ap proyal granted which is bagd_d'upon or is granted in'
,
reliance upon any Material misrepresentation orkfailure to mdke.a maieriaF'fact 6r'`2
`'=circumstance known by or on behalf of an applicant,shall b "o"id
,q w.
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.
S(gnatijrelof responsible'per-son
Daite
Septic Inspection Report
-Office No. (518)761-825 6 Date Inspection request received-
*
Queensbury Building&Code Enforcement Arrive: anilpm De�art_.- �_- 'arn/prn�
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: l K PERMIT NO.:
LOCATION: ,7
INSPECT ON:
RECHECK:
ype: 'Sand.nd ay Comments and/or diagram
-9-0-ii_T
Type of Water: Municipa!2Well Water
Waterline separati-o-n-t-isCance
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: _75;
Piping Size Type
Building to tank 1 (Ay�
Tank to Piatuli a�t-B�x 15 09 _3577
Distribution Box to Field Pit
Opening Sealed: Y/NI Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits
Conforms as per Plot Plan --dy
Locat ystem on Property:
Fro Rear Left Side Right Side
Middle Front Middle Rear
System Use Stat4
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
_ "! Laq
• SUN 2 h 2043 L
"I have seen or observed, or believe I saw evidence of, S5URY
all objects such as houses, wells, trees, fences, etc., �®��®r QUe C<3��
shown,on this document. I also represent that I have t3
personally measured the,distances set forth on the diagram."
S TURE DATE
TOWN VY
BUILDING &
REVIEWED BY
DATE
t;
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1 1 t