2002-072 f TOWN of OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518)761-8256
CD
Eft'I'IFICATE OF COMPLIANCE
Permit Number: P20020072 Date Issued: Thursday,January 31,2002
This is to certify that work requested to be done as shown by Permit Number P20020072
has been completed.
Tax Map Number: 523400-300.016-0001-005-000-0000
Location: 231 FULLER Rd
Owner: JOSEPH&LEONA BRAYTON
Applicant: 10SEPH&LEONA BRAYTON
This structure may be occupied as a:
By Order of Town Boatd
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: P20020072 Application Number: A20020072
Tax Map No:, 523400-300-016-0001-005-000-0000
Permission is hereby granted to: JOSEPH&LEONA BRAYTON
For property located at: 231 FULLER 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: JOSEPH& LEONA BRAYTON Septic Alteration Residential
231 FULLER Rd Total Value
QUEENSBURY,NY 12804
Contractor or,Builder's Name Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
QUEENSBURY.NY'
Plans &Specifications
2002-072
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,January 29,2003
(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 To"\ Of 'Ins ary 29.2002
SIGNED BY -for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal Syste �Cp
Town of Queensbuiy 742 Bay Road Queensbury,NY'12804 (518) 761- 56 VP1
1. OWNER INFORMATION: 2 N 2
o.............................
wlv f ri OR........................................
Location of installation;* . .....
QQ&Q O P 0 C!
Tax Map No. File Perm
Owner's Name: C,-Cf rO Al Fee Pai
Address:
2. -'INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION-' (circle year of dwelling,indicate#bedroom(s) and multiply# Qf
bedrooms with applicable gallons per bedroom toequal total daily flow)
Year of House: No. of Bedrootns x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm =
1980= 1091
x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes no
Spa or Whirlpool Installed yes_ no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
P'lat pstraphy and ature Ground Water Bedrock or Impervious Material Domestic Water Supply
T-n at w a �-pth at=wt epth municipal
ling Let meet well
Steep slope clay
if well; water supply
Va slope other
from any septic-system
depth: absorption is_fl.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
z
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-
A-9-no—gallon(min. size 1,000 gal.)
Tile Field: each trench_fl. Total System Length:
Seepage Pit(s): number of size ofeach: _fl. by_fl.
Size of Stone to be used: # depth or thickness feel
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 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 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.
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TOWN OF QUEE�/
REVIEWED By
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DATE
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seen or,observed or beliet►e 1 saw evidence of,
a!I cb ects such a,�houses; v�;ells,trees;fences, etc.,.
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t that I have
shown on this Ltl'� ".art}.diatances set forth Sri the dlaram:'
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SITE A.
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