2001-188 TOWN OF QUEENSBURY
ET
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE
OF COMPLIANCE
Permit Number: P20010188 Date Issued: Tuesday, April 24, 2001
This is to certify that work requested to be done as shown by Permit Number P20010188
has been completed.
Tax Map Number: 523400-119-000-0003-002-002-0000
Location: 59 LUPINE Ln
Owner: S 1'EVEN JAMES
Applicant: STEVEN JAMES
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
,414
1/9
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: P20010188 Application Number: A20010188
Tax Map No: 523400-119-000-0003-002-002-0000
Permission is hereby granted to: STEVEN JAMES
For property located at: 59 LUPINE 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: STEVEN JAMES Septic Alteration Residential
59 LUPINE Ln 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
2001-188
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,April 24,2003
(If a longer period is requited,an application for an extension must be made to the code Enforcement Officer 9
of the Town of Queensbury before the expiration date.) -
Dated at the Town ensb Tuesda ,April 24,2001
SIGNED BY for the Town of Queensbury.
Director of Building&C de En rcement
•
Application for Permit—Septic Disposal System
Town of Queens•biny 712 Bay Rood Qut'e,rs wy, NY 1280.1 (518) 761-8256
1, OWNER INFORMATION: Sin •
•
• Location of installation: �9 Office Use
Kilo Tax Map No, / / I'ornrit N�Jf Ali ST
_ 66
i
Owner's Name: C1 J �/p_._ {�j- PIe t I►oo Paid C: .
Address: ‘9 - — • ---34ftlie CAU,101,,afLi lattiWr-
alr\
2. INSTALLER'S NAME : 407 41.47e/c-, PHONE NO.79 r-
7 '
3. RESIDENCE INFORMATION; circle yea,. ►( ) o('dwcllmt„ indicate ll bedroom(s) and multiply !l of
bedrooms with applicable gallons per bedroom to equal lola/daily flow)
Year of House: No. of Bedrooms x Computation - 'Total Daily Flow.
1980 or older '
x 150 gal/burnt = ��5 0 IF*
1980- 1991 . ���
• x 130 gal/burnt =
1991 —present x 110 gal/bdrtn = An 2 3 20
Garbage Grinder Installed yes / rto t®f OVEENSBUB\f
Spa or Whirlpool Installed yes / no OWN AND C®
4. PARCEL INFORMATION: (circle applicable information & indicate Inoastltetnetlts)
4v5._
aphy So' 1 ut_o Ctyuitd W8LCi_ Bedrock_.Qr Ipeivig_ s Materialmot ai whrr,dep,hcr,u'hr►,drr „%► flier Supply
(lug / norrrielpr►/ f ---
' fie'( feet .e
Steep slope clay -
slope other Oval; wider supply
depth: from,any sl.'ptic;-s)slem
absoi jition is .11.
• •
Percolation Test: (robe eompleted by licensed prvfLssional engineer or architect) other_
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 apptuved subdivision). Add 251) gallons to the size
• of the septic lank and leach li'Id for each Gat bage Grinder, Spa or Whit Ipoul Tub.
(c(-7-7Ai Co
• SeIticIauk:K1-93 gallon
(min. size .1,UOU gal) 7L ,- ��40
Tile Field: each trench gb ft. Total System Length:(4-74.)-
r C) it.
Seepage Pit(s): number of / size Trench: 11. by ft•
Size of Stone to be used: 11,_/V ` / depth or thickne.t __ inft
I3ed System Size: AV A-A- 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 iho Code of the Town
of Queensbut•y, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or ri►iluro to make a material ritct or
circumstance known by or on behalf of an applicant, shall be void.
! hove re o regulations with respect to this application aunt twee Io abide by these and all '
requir moats o We'!'own of Quecusbuty Sanitary Sewage Disposal Oidivar •e.
1. 07:s3191
,. Ig slurs of re on ble person Date
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 cAk0.Y
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name L� \-(2
/�i �G`lYY\Q�
Location 59.
Date-- -L( 6) Permit 660j —1 g3
SOIL TYPE- San Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: ____7
ABSORPTION FIELD: Total Leaat / aOO
Length of each trench
Depth of trenches '
Size of stone 4,p- sue'
SEEPAGE PITS: Numbe -
Size - ft. x ) ft.
Stone size /
PIPING: Si- e Type
Bldg. to Tank
Tank to Dist. Box 1 ;kle �5--
Dist. Box to Field7P' -
Openings Seal e$l?7 es No . :Partial
LOCATION/SEPARATION
Foundation to Tank ,lV Efeet
Foundation to Absorp (i on . _ () .feet . .
Separation of Pits feet
Conforms as per Plot l an No
LOCATION OF SYSTEM ON PROPERT
(circle o� •
Front - Q tide - Right Side
Middle • • t - Middle Rear
COMMENTS: . .
•
SYSTEM USE APPROVED: NO
Arrived:
Departed: I
4(al,/
Building Inspector
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/ C/c' een or observed or believe I saw evidence of, I
all object such as ho es, Ils, trees, f ces, etc.,
own on this docume t. I a o reor that 1 have
woo aqi ql.
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