2003-791 TOWN OF QUEENSBURY
742 Bay.Road,Queensbury,NY 12804-5902 (518)761-8201.
Community Development-Building&Codes (518)761-8256
OMPLIANC ,CEixTIFICATE .QFCE
Permit Number: P20030791 Wtelssued: Wednesday, September 24,2003'
This is to certify that work requested'to be done as-shown by Permit Number P20030791
has been completed:
Tax Map Number; 523400-295-014-0002-070-000-0000
Location: 28 MOUNTAIN VIEW Ln
Owner: KI M&MARGARET VYDARENY
Applicant: KIMM&MARGARET VYDARENY
This structure may be occupied as a:
By Otder of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
c
Di ectot 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 Numben, T20030791 Application Number: A20030791
Tax Map No: 523400-295-014-0002-070-000-0000
Permission is hereby granted to: KTMM&MARGARET VYDARRNY
For property located at: 28 MOUNTAIN VIEW 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 of Construction Value
Owner Address: KEMA4&MARGARET VYDAREN
Septic Alteration Residential
28 MT. VIEW Ln Total Value
QUEENSBURY,NY J2804
Contractor or Builder's Name Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2003-791
SEPTIC ALTERATION AS PER-PLOT PLAN SPECIFIATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, September 22, 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 Town of Queensbury; day, September 22, 2003
SIGNED BY for the Town of Queensbury.
'�+iMA W
rectbr of Buildin5/&Co Enforcement
Application for Permit—Sepijc: Disposal System
Town OfQueensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER ZWORMkTION-
Location of installation: 2,P 0&_j LAAI-rt. Office Use
Tax Nfap No. File Permit No.G40 -7__
Owner's Vvl)(4REj1f L Fee Paid
...
Address: 2, V/a .... .........c-j Aj
2. INSTALLER'S NAME - —A t PHONE NO.7 2--7 25`7
3. RESlDE1,TCEI11qFORN,1ATTQON: (circle ye r of�dwelling,indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: Bedrooms x Computation = Daily Flow
ot e - x2=1
1980 or older S- x 150 gallbdrin =
1980—-1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed Y.PS no 9
Spa or Rot Tub Installed VE
yes— no e SEP 9 2003 U
4. PARCEL INFORMATION: (circle applicable information&indicate measurements) 7*0VVjV OF
T n1r?,9UEEA/.qRi fin%,
h S Ground Water Bedrock or Imnervious Mggjal —nQ==b3 M- EgteMvSTV
0 0
at what depth at what depth isru-nici
01117 feet —feet we
Steep slope clay if well;water supply
VC.slope other
from any septic-system
depth: I I absorption is_ft.
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 systerns 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 Ox-finder,Spa or Whirlpool Tub.
Septic Tank: gallon(min. size 1,000 gal.)
Tile Field: each trench Total System 1-,,Zth:
SeepagePit(s): number of_ size ofeach; __fk. by_fr.
Size,qX Stone to be used: #—/u IA- / depth or thickness feet
:Bed System Size: x
Alternative System-, length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: I 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 13 6-29 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
requiremen f the Town of Quc Sanitary Sewage Disposal Ordinance.
f ury
Si
Ure of
Si na ure of responilble person ate
TOn/TnO 01 XVa VV:VT MIL COOZ/TO/LO
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury.Blii1ding&Code Enforcement 'Arrive: am/ boart: am pm
742 Bay Rd., Queensbuiy,NY 12804 Inspector's hiitials:l�—
NAME: I<- PERMIT NO.: 0
LOCATION: LOY INSPECT ON: 2�
RECHECK
Comments and/or diagram
Sol]T e: L a as �Vlay
Sail
T TDwTe of W Municipal Y Well Water
Waterline se ration dist ce
Well
ep tjo
Well separatio istan
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench V ft.
Depth of trenches ft.
Size of Stone
-Seepage Pits: Number
Size: x
Stone Size:
Piping Si4e, Type I.-
Building to tank '5.4b
Tank to Distribution_Box -5f-
Distribution Bo xA FNild Pit
Opening Sealej. Y/t/Partial
Location/Separations
Foundation to tank
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan Y N
Location of Sys on Property:
Front Rea' Left Side Right Side
Middle5ont Middle Rear
System Use Stat
Approved
Partial Approved and needs to be re-inspected,please call the'Building&Codes Office
Disapproved
L:\SueHe,mingway\13uilding.Codes.Inspection.FORMS\Septic Inspection kepori.doc; January 28,2003
.AL
RECEIV�D
SEP 19 2003
` ` St-
TOWN of
�ul��lnl QAED colUR Y
TOWN OF QUEENSBURY BUIIDIN DEPARTMENT
Based on our limited ex- !nation
comppliance with our comm nts shah
not be construed as indic tin' the
compliancewith he Buildin 3 Codes
of New York state.
BUILDIiVG & t -PT.
REVIEWEp 13Y
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this doc ,4 I also represent that I have
nrronI measure th d Lance orth on th diarro
r
SIGMA DATE