2003-727 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: P20030727 Date Issued: Wednesday, September 03,2003
This is to certify that work requested to be done as shown by Permit Number :. ' P20030727-
has been completed.._.��...,.....�... - . .u+. r�. -
Tax Map Number: 523400-309-006-0001-040-000-0000
Location: 23 NATHAN St
Owner: CARL&LINDA WINCHELL
Applicant: CARL&LINDA WINCHELL
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code nforcement
TOWN OF ,QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes.(518)761-8256 '
BUILDING PERMIT
Permit Number: P20030717 Application Number:. A20030717
Tax Map No: 523400-309-006-0001-040-000-0000
Permission is hereby granted to: C;ARI,&-LINI)A WINC;HFI,I,
For property located at: 23 NATHAN St
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 Unifortri Building Codes and the Queensbur'q Zoning
Ordinance. - Type of Construction Value
Owner Address:- CARL&IINDAVINCHELL
23 NAPHAN St Septic Alteration Residential
Total Value -
QUEENSBURY,NY 12804
Contractor or Builder's Name'/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELL.OS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2003-727
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES Friday;September 03, 2004..
6f a longer period is required,an-application for an extension must be inade to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at a To ' 'of Q n esday, September 03,2003
SIGNED BY for the Towii of Queensbury.
Director of Building&Code Enforcement
Application for Permit Septic Disposal System
Town of QUeensbur•y 742 Bay.Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
----- Office TJse
Location of installation: 2,3iVA' ! A"y1.1 J
Tax Map No. / / I File Pernut No.y
t3 Q
W �Owner's Name: i Fee Poi r.
Lj
_....._..,_....�.Address: 2-2AJ Aay 1S''71rf e,�1' ;Y._�...-200.3._......_.._,.
TOWN 01=
2. ZNSTAI,LER S NAM£ PHONEN` U�3Y
3. RESIDENCE R WORMAThON: (circle year of dwell ,indicate#bedroom(i) and multiply##of
bedrooms with applicable gallons per bedroom to equal total daily flow)
'Year of House: No of Bedrooms x Computation — Total Z7ai1y Flow
1980 or older x 150 gal/bdrm =
1980— 1991 x 130 gal/6drm = G
1991 —present x 110 gal/bdrrn =
Garbage Grinder Installed yes / no`1
Spa or Hot Tub Installed yes a / no a
4. PARCEL INFORMATION: (circle applicable information fir indicate.measurements)
Tonoy-raphy So' Nature Ground.Water Bedrock-or Im ervi us Material D2Mestic Water Supply
Flat sand at'what depth at what depth municina1
Rolling corn feet feet well
Steep slope clay if well;water supply
—/o slope other from any septic'-system
depth: absorption is ft.
Percolation Test: ( o be completed by licensed professional engineer or architect) other
Rate. minute per inch j
S. 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 eac Garbage Grinder,Spa or Vdltirlpool Tub.
�i� �_, ��
11
Septic',lank: 1 Q20 gallon(min.size J,000 gal,) ° `��
Tile Field: each trench- ft, Total System Length: a�y o fi.
Seepage Pit(s): number of 81 1 A, size of each: __ Y, by ft.
Size gf Stone to be used: t# / depth or thickness feet .
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK.SYSTEM: (if required)
Number of tames: / 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 &RS FORMATION 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 re a regulations th r spect to this application and agree to abide by these and all 5
require nts f the Town u nsbury S ary Sewage Disposal Or cc.
ig a ure of ress ons ble person Date
Xva rr_:r_i 9111 COOZ/TO/LO
COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC.
Main Office 176 Doe Run Road Of Manheim, PA 17545
MUNICIPAL CERTIFICATE a ELECTRICAL APPROVAL
No
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No.
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Installation Consistln of �u I
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The conditions following governed the issuance of this certificate, and any certificate previously issued ii
cancelled:
This certificate only covers the electrical equipment and installation conditions as of date, Upon tht
introduction of additional equipment or alterations, application shall he ptly made for inspection!
Inspectors of this Company shall have the privile e o aking inspe tions at any time, and if it,
rules are violated, the Company shall have the right to ev a his c rtificate.
#>, y,/dry' �
Date,,, ffi.i}iN.i#R#f i#,4fiiY4.{...iff1.#4#Iflf! INSPECTOR
fppf 4i4ffiiii i.iiiN •pNN#!ff#ffiN#N###R!!#!!lffR##Rfyf41}i#fllNfif4pff!#4NR,
Mamhar N 17D A 1 A V 1
Septic Inspection Report
Office No.(518)761-8256 Date In ection request e
sl��a a 1-U a�Tt5;�
Queensbury Bu ilding&Code Enforcement 'Arrive:
742 Bay Rd., Queensbury,NY 12804 Inspector's Initia
NAME: ®RMITNO.: C`)3>
LOCATION: INSPECT ON: C)
RECHECK:
Comments and/or diagram
Soil jK. SanjQfjj��Clay
Typeo �u4icip-W
- I-W*R-Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench 1.
Depth of trenches
--.Size of� tone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type,.
Building to tank \,2,
t2
Tank to -7
Distribution Box 1 t Wiet Opening S Ial
Location/Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits
Conforms as_per Plot Plan %L"'Y_N
Location of System on Property;
Fr t Re t Right S'
Middle Froi 'Middle Rear
System Use Sta s:
Approved
Partial Approved and needs to be re-inspected,please call the*Building&Codes Office
Disapproved
L:tSue,Hemingway\Building.Codes.Inspection.FORMS\Septie Inspection Report.doc January 28,2003
411
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TOWN OF QUE NSBURY BUILDING DEPARTMENT
Based o odr limited examination,
complian with our comments shall
not be c nstrued as indicating the
plans an specifications are in full
comp with the Building Codes
of New State.
TOWN ar QUEENSBURY
BUILDING & C E T
DATE a
retie seen or observed, or believe I saw evidence of,
-oleos such as houses, wells, trees, fences, etc.,
rrvn on this docume also represent hat I have
soy, ify measured t . di ances t h on th diagram."
SIGNAT R 2-9 b
DATE