2002-249 TOWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CEA111IFICATE
Permit Number: P20020249 Date Issued: Thursday,April 18,2002
This is to certify that work requested to be done as shown byPermit,Number P20020249
has been completed.
Tax Map Number: 523400-302-014-0002-008-000-0000
Location: 19 DIXON Ct
Owner: STEPHEN&ANNETTE DUELL
Applicant: STEPHEN&ANNETTE DUELL
This structure may be occupied as a.
By Order.o£Town Board -
Septic Alteration Residential TOWN of QUEENSBURY
Dizector of Building&Code En orcement
TOWN OF QUEENSBURY
742 Bay Road;Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020249 Application Number: A20020249
Tax Map No: 523400-302-014-0002-008-000-0000
Permission is hereby granted to: STEPHEN&ANNETTE DUELL
For property located at: 19 DIXON Ct
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&ANNETTE DUELL Septic Alteration Residential
19 DIXON Ct , Total Value
QUEENSBURY,NY 12804
Contractor or.Builder's Name/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2002-249
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES. Friday,April 11,2003
(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 th ' o of Q 6kns ury; rsday,April 11,2002
SIGNED BY for the Town of Queensbury.
urY.
Director of Building& ode Enforcement
518 745:4437
,FILE No.638 04r02, '02 AM: 11-:25_I D:TOWN OF 9UEENSBURY -FAX 518 745"'A437. PAGE " 1
Application for Permit-�Septic Dlspo+a:zl System
ToWTt.o ueetrsbury 742 Bay R--ad Q,eensbury.NY•1?804:
I. OWNER INFORMATION;'` �•-- � OtiiceUre . ��._...�._._
Location o£#istallation i �!' F" •
File r��-
Tax Map Na., / /
: lj � 7�-/l� , Ue Fee Pa_—.,(f E
a ' P �..
Owner''s Name ••
Address: k �n 3 Ci� R
fl
0WN OF QUEENS13URY
2. INSTALLER'S NAME
3. RESIDENCE INFORMATION: (circle year of dwell i icate#bedroom(s) and multiply-4 of
bedrooms with applicable gallons per bedroom to equal total datlyflow)
Year or rsou�Q. _ -Na.ofBedroo _2C c�Utjwgu. •: ' `>~ocu/Daft Flow
1980 or older : x 150 gal/bdrm
1980—,1991 x 130 gaVbdrm,
1991 —present x 110 gaVbdrin.
Garbage 0rinder Installed. . . yea_ / no °<
Spa or.Whirlpool Installed yea _. / no s-
4. Pp,RCEL,;INgORMATION: (circle applicable information&'indicate measurements} _
at what depth at what depth tlun�ioiRotting m ,feet feet l..Steep slope,,;• ",clay; well,water supply
�%°slope other-.. from any septic-system
depth:, absorption is f}
other
percolation Test (To be completed by licensed professional engineer or arphttect)
Rate: mfoute per inch
S. PROPOSED-S"YSTFNl:.'B'or j3o%Cogirtruction: All individual 96*890 disposal systorns must be designed by a licensed
prc*xdonal engineer or architect(unless installed in a planning Board approved subdivision). Add 250 'gallons to the rite
of the septic tauic and leach field for each Garbage Grinder.Spa or Whirlpool Tub.
Septic Tank _ . ' g.ctllon(min size 1.000 gal.)
Tile Field: each ireiirch 1? Total System Length: f!
seepage Pws):. -numberaf PO size of each: by 1
Size of Stone to be xused: 0 f depth or thickness feet
Bed SystemSiza,. x
Alternative Syr tM:. length and/or size
6. HOLDINO 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 Town approved
electrical inspection agency:
7. SIGNATURE &INFORMATION FOR RESPONSIBLE pERSON,(please read)
For:your prvteotion;please note that pursuant to Section.136-29 of the Code of the Town
of Queerisbiixy;any parmit'or approval granted-which isi based upon or,is granted in
reliance upon any material misrepresentation or failuxa t'o'make*'material act or
nimuinstance known,by or.on behalf of an applicant, shall be,void. ,
I have react the regulations-with respect to this application sad agree to abide by these and all
requirem e,Town of Queen ury Sanitary Sewage Disposal Ordinance.
Date
81 na re of re�sp¢inisible person'
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
'j 42 ,- Bat-v Rcoact
Que!ansbuv-_y NY 12864
SEPTIC DISPOSAL SYSTEM INSPEC-rYON
>
Name
D a-t e-Z4 #
SOIL. TYPE=4Sah Loam-Cl ay-
R -SU1tS of ar-cnla_ti can Tost-
( iF applicable ) Rai--e-Minu-te/ Inch
TYPE OF SYS-TEP*=
ABSORP- "ION FXEI-D-- To-tal Lancrt�,
Length of each t-r-e-nch i!�;�
Depth of trenches I--z_ -
Size o-F S-tana Z:2�=2��E
SEEPAGE PI-rS : N (Imt>e- r--
Size - f,-t X
Stone size
PIPING: S - Type
Bldg - to Tank
Tank -to Dist _ -Box
Dist— Box to Field/P -t -5
open -ings Sealed ? es No - Part I al
E0C.A-TICW1ZSEPARAYIOH E>Founda�tion to Tank
Foundation 1--iD 'Absor-p -ti on -F a a
Separation of - Pits at
Con-Forms as per PI o-t PI an �y�c--
0
I-OCA"TX '%YS-rEM ON PROPER-FY:
( circle -Front Lef-t SidoEi -- Right S i de-
on
Middle Mid dl- a Roar
COMMEN-IrS
SYSTEMS - USE APPROVED= YES no
r
RECEIVED „ wearer au, uo
a�+ey ley, s nue
A P R 0 2002 1 41�utrsaacraa paansea
`jo a�u .919 saoual `saaa� ,s are, ua +1 30 s14a
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BUILDING AND CODE Mes C anarraq as "PaAaasq0 aoauaac
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TOWN OF QUECEN4431,BURY
BUILDING & _p p`I`:
REVIEWED BY
DATE p?i
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