2003-445 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: P20030445 Date Issued: Friday,June 20;2003
This is to certify that work requested to be done as shown by Permit Number P20030445
has been completed.
Tax Map Number: 523400-302-014-0002-040-000-0000
Location: 15 NORTHUP Dr
Omer: STEPHEN&CLAIRE MORRISSEY REVOCABLE TRUST
Applicant: STEPHEN&CLAIRE MORRISSEY REVOCABLE TRUST
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: P20030445 Application Number: A20030445
Tax Map No: 523400-302-014-0002-040-000-0000
Permission is hereby granted to: STEPHEN& CLAIRE MORRISSEY REVOCABLE I
For property located at: 15 NORTHUP 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: STEPHEN& CLAIRE MORRISSEY' Septic Alteration Residential
P MORRISSEY TRUSTEE Total Value
15 NORTHUP Dr
QUEENSBURY,NY 12.804
Contractor or Builder's Name Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2003-445
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 -PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,June 20,2004
(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 awn ue3 a.i June 20,2003
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
l.- OWNER INFORMATION:
Location of installation: 01
JS 0ff*'i'c'e Use--...................*
( i
Tax Map Na. File Permit Nk)�
Owner's Name: Fee Paid(
..................................................................................
Address: C
2. INSTALLER,S NAME
PHONE No.
3. RESIDENCE INFORMATION: (circle y s) and multiply#
ear of dwelling, indicate#bedroom(
bedrooms with applicable gallons per bedroom to equal total daily
200.?
Year of House: No."of Bedroom x Co=utation Total Daily Flooviv(D..QLJC -
&AlZ�
1980 or older _
x 150 gal/bdrm ZZZ ftAft Csa u Ry
x 130 gal/bdrin
1991 —present x 110 galfbdrin
Garbage Grinder Installed yes_ no
Spa or Hot Tub Installed Yes no
4: PARCEL INFORMATION: (circle applicable information&-indicate measurements).
To 0 h Soil Nature Ground Water Bedrock or Imi3ervious Material Domestic Water Suipip]
P-
sa at what depth at what depth municipal
Rolling loam —feet feet well
Steep slope clay if well, water supply
Yo slope other from any Septic-system
depth
absorption is
Percolation Test: (To be completed by licensed professional engineer or architect) 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: IIX5j
gallon (min.size 1,000 gal.)
Tile Field: each trench-j 4-ft, Total System'Length: ft.
Seepage Pit(s): number Of---2=-- size of each: ft. by 6 ft.
Size Of Stone to be used: # depth or thickness 2 feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons TOTAL Capacity: gallons
Note: Alarm System and associatedelectrical-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
require he Town of Qlf-celis[bury Sanitary Sewage Disposal-Ordinance.
ig atur,
ig ature of re.spoKsible person Date
Septic Inspection Report
Office No. (518)761-8256 Date Inspection reque e e ed: !>
Queensbuiy Building&Code Enforcement 'Arrive: ' a pme rt: In
742 Bay Rd., Queensbury,NY 12804 Inspector's Initial
NAME: K)12-2 X PE NO.:
LOCATION: --Asb- b,�gMAA2 OR IN ECT ON:
RECHECK:
Comments and/or diagram
Soil Type/ Sand oam Clay
TYpe of at !n-iQiPajr1 Well Water
Waterline separati'bn-MtVce
Well separation distance
Other,wells:
Absorption Field: Total length
Length of each trench
...Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Pi in Size Type
N,
Building to tan
Tank to Distribution Box )AV,
Distribution Box Pit
K#091-
Opening Sealeq M-7 Partial
Location/Separations
Foundation to tank
Foundation to.abs2p2tion
Separation of Pits
Conforms as per Plot Plan Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front dle Rear
System Use St s:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
-Disapproved
L:\Suelieniingway\Biiilding.Codes.Iiispection.FORMS\Septic Inspection Rcport.doc; January 28,2003
...........
evidence
e1�e�e i s ier�ce�,
seved° gees, t have
c, e Seed Cl 4 `�ti�}S, t?S � }kt the(�2� ' m'
1
ati c��ects s�!e� ccllmeet,l pis ` -s
pels
JUN 2 .0 003
TOWN OF QUEE SBURY
BUILDING AND 'ODE
BUILDING &
REVIEWED BY
DATE
Z_ y. `
°F .�
bc
� �a