2002-302 TOWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CE.RT"'IFICATE OF COMPLIANCE
Permit Number: P20020302 Date Issued: Friday,April 26,2002
This is to certify that work requested to be done as shown by Pen-nit Number P20020302
has been completed.
Tax Map Number: 523400-296-061-0001-013-000-0000
Location: XQUEEN'S Way
Owner: TERRENCE KARANIKAS
Applicant: TERRENCE KARANIKAS
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential 'TOWN of QUEENSBURY
Director of Build Co 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: P20020302 Application Number: A20020302
Tax Map No:, 523400-296-061-0001-013-000-0000
Permission is hereby granted to: TERRENCE KARANIKAS
For Property located at:
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
Owner Addr6ss: TERRENCE KARANIKAS
PO BOX 4621
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
TERRENCE KARANIKAS
)(OUEENSWAY
OOEENSBURY,NY 12804
Plans &Specifications
2002-302
SEPTIC ALTERATION AS PER APPLICATION
$25.60 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,April 26,2003
(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 a(�Ze T I a u nsb Friday,April 26,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System
Town of Queensbwy 742 Bay Road Queensbury,NY 12804 (518) 761-8256 I�
1. OWNER INFORMATION: -� •-----
Office Use
Location of installation:
i "File Permit Noz��oZ
Tax Map No. �/ `{ ! /I
Owner's Name:
S Fee Paid
Address: AA
2. INSTALLER'S NAME 2l� �+�. PHONE NO. Z7�I
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s)and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily ®?
�'
Year of House:: No.of Bedrooms x - Computation Total Daily Flow
'APR -9 3 2002
1980 or older s. Z- x 150 gal/bdrm = 306_ 1"
1980- 91 x 130 WA N®
19 �C}U EE SBURY
1991-present- x 110 gal/bdrm �®-- n _ - CODE
Garbage Grinder Installed yes_ 1 no
Spa or Whirlpool Installed yes_ ! no
4. PARCEL INFORMATION: "(circle applicable information&indicate measurements)
Tobography Soil Nature Ground Water. Bedrock or ervious Material Water Su 1
ell-at.. ' san at what depth at what depth rMunicipaolling oam w �-feet z/ti eet Steepslope = clay ater supply
_%slope ` other septic-system
depth: on is ft
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 'ceztsed .
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.) ", rl 1-5
Tile Field: each trench fit Total System Length: }t
tee`
Seepage Pit(s): number of " l size of each: fit by o fit -2 S�
Size Hof Stone to be used: # �" / depth or thickness Z- feet f
Bed System•Size: x
Altemative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number"oftanks: / Size of each: /TOTAL" Capacity: gallons
i
r
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 the Code of the Town
of,Queensbury,any permit or approval granted which is based upon or is granted jn
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 Town of Queensbury Sanitary Sewage Disposal Ordinance.
l�
Signature of responsible person Date
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