2001-115 TOWN OF QUEENSBURY
ueensb NY 12 4-59 2 (518) 761-8201
��� 742 Bay Road, Q ury, 80 0
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010115 Date Issued: Thursday, May 03, 2001
This is to certify that work requested to be done as shown by Permit Number P20010115
has been completed.
Tax Map Number: 523400-301-006-0002-088-000-0000
Location: 5 SWEETBRIAR Ln
Owner: JAMES &KOULA KURKEMELIS
Applicant: JAMES &KOULA KURKEMELIS
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
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Director of Building& Code Enforcement
TOWN OF QUEENSBURY
---4y 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010115 Application Number: A20010115
Tax Map No: 523400-080-000-0001-025-064-0000
Permission is hereby granted to: JAMES &KOULA KURKEMELIS
For property located at: 5 SWEETBRIAR 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: JAMES &KOULA KURKEMELIS Septic Alteration Residential
14 SECOND St Total Value
LYNBROOK,NY 11563
Contractor or Builder's Name/ Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans &Specifications
2001-115
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,March 21,2003
(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 Town,.of ueensb ; Wedn sday,March 21,2001
SIGNED BY , for the Town of Queensbury.
Director of Building& ode forcement
. ,
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queenslittry, NY 12804 (518) 761-8256
1. OWNER INFORMATION: 3-0 .— I -05.(09
i
. Location of installation: 7:11c) 6 C 7 n le 11_....r Office Use
File Permit No.00_
0/—/L
Tax Map No. -/ / .
Fee Paid
Owner's Name: 'i" C'S kl.)I.; e inel-05
rTa
Address;4 s-- 5- ,,_ , dr,',..k. r
2. : INSTALLER'S NAME : __I ( 8 c. s-,ifi 'i ; C PHONE NO.),r- -(fi(<
3. RESIDENCE INFORMATION: (circle year of dwelling; indicate#bedroom(s) and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: . No, of Bedrooms x Computation -= - Total Daily Flow
1980 or older x 150 gal/bdrm ..,-7 q cd 9' ec- C
1980- 1991 . x 130 gal/bdrm, •,---
1
1991 -present x 110 gal/bdrm -. .. r
,, .. RELf
Garbage Grinder Installed yes / no K
mAR 2 1
Spa or Whirlpool Installed yes / no
TOWN OF Co.t.ir,,F.::-M.RY
'i .. 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) BUILDING
4 i il I 0 g t , .-in I WN 1 ULM-- SAP41(3 n to_ Bedko ckprnipotv_oms.N*.r.i _DonieslicW ater_Supply(Cr a !ib?,)(p h at kip P allig=Mg loam rtfet peet we
Steep slope clay
if well; water supply
%slope other , ' from any septic-system
depth: .
absorption is ;11.
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 systems must be designed by a licensed
i
i,
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons lo the size
1 . ,of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. .
i Septic Tank //)0 0 gallon (min. size 1,000 gal) '
Cke5'7-; &-c_
Tile Field:. each trend V ," I ft. Total System Length: -R(96 ft.
Seepage Pit(s):" number of size of each fl by ft.
Size of Stone to be used: ' il D--..., / depth or thiekness; /_____Pet
Bed System Size: i 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)1
- For your protection, please note that pursuant to Section 136-29 of the Code of the Town
of'Quoensbury, 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 behalfof an applicant, shall bo:3 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: I
WmattTreiTliespo 81 le person Date
TOWN OF QUEENSBURY . ��
BUILDING &_CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Nam J 1 r$ �G. i--e +-r► 11 S
Location J S77/ 'er'
(Ae 15,A4 i Permit tp.2,00/-//,5
SOIL TYPE: (Sand- •.m-Clay-
Results of. 'ercolatio Test-
(if applica•le) Rate- 'nute/Inch (
TYPE OF SYST'.M:
ABSORPTION FI,LD: Total engtty -j-O
Length of each trench \
Depth of trench- 2
Size of stone .
SEEPAGE PITS: NU ,er-
Size - ft. ft.
Stone size
PIPING: Sire Type
Bldg. to Tank
Tank to Dist. Box �0(L3:
Dist. Box to Field/P'' m •)4V" p
Openings Sealed? Ye No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption ; CI feet
Separation of Pits feet
Conforms as per Plot P1 . - (Ye, No
LOCATION OF SYSTEM ON "OPERT'
(circle
Front - Rea - eft ide - Rig t Side
Middle , int - ' die Rear
COMMENTS:
SYSTEM USE APPROVED: 4 NO
Arrived:
Departed: '' ++
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Building Inspector
1
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"I have seen or observed, or believe I saw evidence of,
all-objects such as houses,wells,trees,fences, etc.,
r I shown on this document. I also represent that I have
person measured a distances set forth on the diagram."
. /. ,ii . 3 -di-- 0,,, .
1 I i - SIGNATURE DATE
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�K( oo 0 RECEIVED
' b _ T�`�` MAR 21 2001
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BUILD NG AND CODE Y
3 V /6 (-/ 5"6,
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TOWN OF it EE &* URY
BUILDING• ; drk"
REVIEWED BY ,
DATE ��`�,..<II_ / , kJ,/ y
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