2001-176 TOWN OF QUEENSBURY
too742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010176 Date Issued: Thursday, April 19, 2001
This is to certify that work requested to be done as shown by Permit Number P20010176
has been completed.
Tax Map Number: 523400-308-006-0001-085-000-0000
Location: 536 LUZERNE Rd
Owner: CHARLES &ESTELLA TROMBLEY
Applicant: CHARLES &ESTELLA TROMBLEY
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(--- ewP/f
Director of Building&Code Enforcement
, TOWN OF QUEENSBURY
t;tiN 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010176 Application Number: A20010176
Tax Map No: 523400-121-000-0001-031-002-0000
Permission is hereby granted to: CHARLES &ESTELLA TROMBLEY
For property located at: 536 LUZERNE 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 Value
Ordinance. Type of Construction
Owner Address: CHARLES &ESTELLA TROMBLES Septic Alteration Residential
536 LUZERNE Rd 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
2001-176
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,April 19,2003
(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 ueensbu ; Thursday,April 19,2001
SIGNED BY for the Town of Queensbury.
Director of Building& e E rcement
Application for Permit-Septic disposal System
Town of Qiieerrsbrlry 742 hay Road Quee►►sb►►iy, NY 12804 (.518) 761-82.56
1, OWNER INFORMATION: .
:. • // Office Use
Location of installation: Crvt e't,L.#,._ 47-'0
CD
Tex Map No. / / Kilo I'oriuit '------7-
,- 7
k.
Owner's Name. r C� )- t if,(a 0 ,,plot
•
/1 pAPR 1 0 2001
2. INSTALLER'S NAME : i' 'A-/Z, ,/' t7 ":/ cv e...— -7-coll,g OF t�� 'II"fl'f - "7' 1;2 - 7,R1 57
3. RESIDENCE INFORMATION. (circloyear'of dwellin ► indiccrke� ririiO r iTiii I multiply If of
bedrooms with applicable gallons per bedroom to equal !oral drily flow)
Year of House; No. of Bedrooms x Computation - Total Daily Flow.
1980 or older x 150 gal/brim' =
'• 1980 1991 x 130 gal/bdrnl =
1991 --present x 110 gal/bdrnr =
•
Garbage Grinder Installed yes / no Y-
Spa or Whirlpool Installed yes / no t -
4. PARCEL INFORMATION: (circle applicable information & indicate measutcu teals)
Tot ,raft _Soil_Na ut_o Grorand Water__Bedrock or linp_elviuus Rates ial
lcrt ut whir/step!!► rri tr%rrrl depthh • io Walcr_Supply
Ro MgInfeet k.
,Sleep slope clay •
--- /`'`'! well
%slope other if well; merle►supply
depth: •
Jim;any septic-s);IYem
absorption is fi,
other Percolation Test: (To be completed by licensed pro fi.�ssional engineer o •architect) _ ��
. -!tale; - minute per inch
5, PROPOSED SYSTEM; For New Construction: All individual sewage disposal syslems must be designed by a licensed
professional engineer or architect(unless installed in a Planning IJoard annoyed subdivision), Add 250 gallons to the sii.e
• of the septic tank and leach field for each Garbage grinder, Spa or With(pool Tub.
/'
• Septic Tank: i 000 gallon (min. size 1,000 gal)
Tile Field: each trench ° It. Total System Length:1-4' fi•
Seepage Pit(s): number,of ifij/A— ,size()leach: fl. by fl.
Size of Stone to be used: Il__Pik_ / depth or thickness,__ ____._.__.._.__.li'a!
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 &INFORMATION FOR RESPONSIBLE PERSON (please read)
For your protection, please note Wat pursuant to Section 136-29 ollito Code or the Towtt
of Queonsbury, any permit or approval granted which is based upon or is granted in
reliance upon any material ntistepresentation or failure to make a material ncct or
circumstance known by or on behalf of an applicant, shall be'void.
• I have re 'ogttbrlions wit It respect.to this application and agree Io libido by these and all
require tout of to Town.of Que bury Sanitary Sewage Disposal Ordinance.
Ig ature of respon Ibis person Date
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545 ,,
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL Ga
Permit No. Cert.NQ \Owner 6"Gl f?in2 G%2/61d/LA 9 •4 7 6 Cut-in Card No.
Location... GA—A-J, r 'r`"�'st�
Installation Consisting of`z 6 "�`� / 2-2 76 7 - S
�/241-1 169- -o.. er q w s/ 5�.b2f1 e 'r,�-�vs�,
/( APIC.
Installed By F` '41, Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon tha
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of makin. ns.ections at any time, and if it:
rules are violated,the Company shall have the right to re ke this ertif ate.
Date /Z/Z D Z/
INSPECTOR
r_
TOWN OF QUEENSBURY 11=3�
-
'! BUILDING &_CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ( Ru ) S
O�
LocatiorEYp LOZER E__ P )
Date W -19-Q1 Permit #2 - t-go
SOIL TYP and- o -Clay-
Resul is of-,Pe'rcol at o6i est-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length Z ,a
Length of each trench 4482. 7)1
Depth of trenches 7► -3
Size of stone 1OFty Ep,�
SEEPAGE PITS: Number-
Size , ft. x II ft.
Stone size r.
PIPING: s , Size Type
Bldg. to Tank% ;_ - itZ4
Tank to Dist. Box
Dist. Box to Fiel �d/Pit 0.-- �c_-�� li a
Openings Sealed? i o Partial
LOCATION/SEPARATI : g
Foundation to.Tank j� ,3 Meet
Foundation to. Absorption '[a feet
Separation of Pits A _ eet
Conforms as per Pl ot; Pl an Yes
LOCATION OF SYSTEM ON PROPE .
(circle one) ,'
Front - Rear -. L 4 ight Side
Middle Front iddle Rear `
COMMENTS: A
,r�
1/1/
� tj
i99
f!
SYSTEM USE APPROVED: / , s
Arrived: i 10► i �
Departed A fit// \`
N/All LII'
:7i1 i 4 Inspe 'o - ' ,f
1\ 4_3
TOWN OF ': EN t •,RY
CI o ti BUILDINGy/ I.RT.m
MI c v' REVIEWED BY
a, moo, �/_.
w z NJ DATE i !�11CTp'
o �
I—
"I have seen or observed, or believe I saw evidence of,
a- a all objects such as houses, wells, trees, fences, etc.,
. on this document: -Iso represe t that I have
a pe sona ly measured the distances ::` orth on the iagra ."
. LJi /
SIGNATF"E D E
v
tc. 2e-x- '--- P—D