2002-130 TOWN OF OUEENSBURY
742 Bay Road,Queensbuq,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CE111110IFICA"10E
Permit Number: P20020130 Date Issued: Wednesday,March 13,2002
This is to certify that work requested to be done as shown by Permit Number P20020130
has been completed..
Tax Map Number: 523400.309-009.0003-022-000=0000
Location: 44 RHODE ISLAND Ave
Owner: BARBARA&NIICHELLE FLINT
Applicant: BARBARA&MICHELLE FLINT
This structure may be occupied as a:
By Otdet of Town Boatd
Septic Alteration Residential TOWN OF QUEENSBURY
Ditectot of Building&Code Enfoxcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT '
Permit Number: P26020130 Application Number: A20020130
Tax Map No: 523400-309-009-0003-022-000-0000
Pen-niss,ion is hereby granted to: BARBARA&MICHELLE FLINT
For property located at. 44 RHODE ISLAND Ave
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: BARBARA& MICHELLE FLINT
Septic Altdration Residential
PO BOX 2543
GLENS FALLS,NY 12801 Total Value
Contractor or Builder's Name Address Electrical Inspection Agency
THREW.JEFF
21 EAGAN ROAD
MOBIL E#796-6005
OUEENSBURY,NY
Plans &Specifications
2002-130
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.06 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,March 05,2003
(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 Tq(Vn AWoue March 05,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System..
Town of Queensbury 742 BavRoad Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: �_ —
a n, .File Permit No.
Tax Map No.c 006,
E
Fee Paid
Owner's Name:; * J ,{GZ I ( 1�P ��' #` 6 i�
I....................
..............................._
Address:Lf 1-1 �l DC f' ? ,�Gl ai5 hC
2. INSTALLER'S NAME t >/cc ��s"�� .- �� C- PHONE NO.
3, RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s)and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No.of Bedrooms x Computation = Total Daily Flow
c-3gl£0 or older x 150 gal/bdrm =
i9:0-1991 x 130 gailbdrm =
1991-present x 110 gal/bdrm =
Garbage Grinder Installed yes_ / no_ RECEIVED
Spa-or Whirlpool Installed yes u / no
4. PARCEL INFORMATION: (circle applicable-information&indicate measurements)
TOWN OF QUEEfeISBURY
To o' h 'Soil Nature Ground Water ` Bedrock or Impervious Material--- --om I e ateR '�1
Flat sand at what,depth at what depth _ lnunzci
o tng oa feet feet we
Steep slope clay tfwell;water supply
F_,%slope other from any septic-system
depth: absorption is ft
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate:: minute per inch
i
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: ��gallon(min.size 1,000 gal.)
Tile Field: each trench cSZ7 _ft Total System Length:
Seepage Pit(s): number of size of each: }t by_
Size of Stone to be used: # —_ / depth or thickness }eet
Bed System Size: x
Ahemative System: length andlor size
6. HOLDING TANK SYSTEM: (if required)
Number oftanks: / 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 Ili INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 136-29 ofthe 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 iesgect to this application and agree to abide by these and all
requirements of the of uesnsb Sanitary'" anita Sewage Disposal Ordinance.
3 /0.
Si nature of respoinsible,person Iyate
TOWN OF QUEEKSBURY
BUJUDING & CODE ENFORCEMENT
1_42 Bay Road
QuoLemsbuv-y MY M2804
(519) 7451-8256
SEPTIC DISPOSAL. SYSTEM INSPECTION
Name
Location
ate D t e P erm I t
SOIL TYPE<San�d- a -Clay-
Results of Per-cola ion est-
( IT applicable ) Rat -Min te/ Inch
It
TYPE OF SYS-TE74= ZZU
ABSORPTIOW FIELD: To_t al L ng-ph
Length oT each ty-enc
C:
Depth of ty-enches
Size of stone, ,.-
SEEPAGE PITS : Psi t9m b.Ell
Size -Ft. Tt
Stone size
PIPING: Zce Type i
Bldg . to Tank -�5 -t-_),
Tank to Dist - Box X
Dist . Box to Field/
Openings Saale-cf ? Yes No Party—C-11
LOCAXION/SEPARAT'll Oft
Foundation to Tank feet
-Foundat 1 on to A b s o rp t I can -Feet
Separ-atIon oV - Pits feet
CoConforms as per Plo-t Plan] —_ Y No
L_OCAT`ICW OF -SYSTEM ON PP, PER
( c I r-C I e
Front -CRe:ar�- - Lae-Ft Sid e - Right Side
Middle t Middle Rear
COMMENTS
SYSI-EM - USE APPROVEDz YES NO
TOWN OF QUE �^
�N URY
BUILDING&
REVIEWEO By
T.
DATE
4a so
D
Based on our Wed exaNnaWn,
notbetonst*asia kg the
(b piaasandspeai�tia�sare��l
M11 oiance With to Code:
V
"I have seenbr observed;or believ I saw-evidence-of,
all objects such as houses,wells,tr es,fences,etc.,
I also re esent that I have
personally easured the 'stances set forth on the diagram"
8Q-1bI1,
SIGNATURE DATE