2002-286 � a TOWN OF OUEENSBURY
742 Bay Road,Queensbuty,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
r1TE OF COMPLIANCE
Permit Number: P20020286 Date Issued: Wednesday,Apfi124,2002
This is to certify that work requested to be done as shown by Permit Number P20020286
has been completed.
Tax Map Number: 523400-295-014-0002-038-000-0000
Location: 16 JOHN CLENDON Rd
Owner: WARREN&MARILYN GONYEA
Applicant: WARREN&MARILYN GONYEA
This structure may be occupied as a:
By Otder of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director o€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: P20020286 Application Number: A20020286
Tax Map No: 523400-295-014-0002-038-000-0000
Permission is hereby granted to: WARREN&MARILYN.GONYEA
For property located at. 16 JOHN CLENDON 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: WARREN&MARILYN GONYEA Septic Alteration Residential
16 JOHN CLENDON Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name Address Electrical Inspection Agency
OUEENSBURY SEWER SERVICE
Plans &Specifications
2002-286
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,April 22,2003
(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 T wn o txee n pril 22,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
r
- Application for Permit—.Septic Disposal System
Town of Queensbwy 742 Bay Road Queensbwy, NJ' 12804 (518) 761-8256
1. OWNER INFORMATION:
Location of installation: ��'} j
File Permit Nogg" i
Tax Map No... ! / r.
j Fee Paid
Owner's Name:AAI �� Csa cam"
I............................_...............................................................................................
,......
Address: •. ^� j
- 1
2. INSTALLER'S NAME : /Y PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, . dicate 9 bedroom(s)and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow) j
Year of House: No. of Bedrooms x = w
ounpu�ation Total Daily,y Flo
O eIr—od x 50 gabd �s !�= Z
x 130 gal/bdrm —� � �
1991 -present x 110 gal/bdrm =
APR 2 2 2002
Garbage Grinder Installed yes r116,
TOWN OF QUEENSBURY
Spa or Whirlpool Installed yes_ / BU'R t?lNG AN'
DI CODE
4. PARCEL JNFORIVIATION: (circle applicable information 8c indicate'lneasurements) (�
t
Topography . : Soil Nature Ground Water Bedrock or Impervious Material Water Supply
17a[ an at what depth at what depth mun it a.
�Iling l0a)# feet well
ope clay if well, water supply
_%slope other front any septic-system
depth: absorption is ft.
other'
-Percolation.-Test:- (7'o be-completed h_y-licensedprofc,.ssional-engineer or arcl7i[ect)
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 title size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank:Z2!? gallon(min. size 1,000 gal.)
each trench ft. Total System Length: O-.>
Seepage Pit(s): number of size of'each: ft. by
Size of Stone to be-used: # / depth or thickness feet i
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 8c 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.
Signs ur of responsib e'person Date
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'R 19 2002
)F QUEENSBURY
►ING AND CODE
;11 have seen or observed,or believe I saw evidence of, .
ell objects such as houses,wells,trees,fences,etc., , _ � � ' ...;.� �„uw.,,.JURY B'ui'�1�iG0EPARTP��IT ,
to` Prjj;,Aon our hedexananalion,
)Nwn on this document. I also representthat I have comoiancewboutoocnnft Oail
Y
personally measured th 'stance set forth o the diagram" not b construed as ink*the
o plansaM pecif`icationsare ihU
IGNRTURE DAT
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j
TOWN OFIDUEEN BURY
BUILDING&C
REVIEWED BY
DATE ----
777
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