2002-342 � TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
TEOF- COMPLIANCE
CEIVA CA
Permit Number:: P20020342 Date Issued; Tuesday, May 07,2002
This is to certify that work requested to be done as shown by Permit Number P20020342
has been completed.
Tax Map Number: 523400-301-008-0002-036-000-0000
Location: 1 COTTAGE HILL Rd
Owner: GARY&KAY LOKE
Applicant: GARY&KAY LOKE
This structure may be occupied as a:
By Otder of Town Board
Septic Alteration Residential TOWN of QU>rl;NSBURY
Director of Building& ode E Vbtcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
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BUILDING PERMIT
Permit Number: P20020342 Application Number: A:20020342
Tax Map No: 523400-301-008-0002-036-000-0000
Permission is hereby granted to: GARY&KAY LOKE
For propery located at: 1 COTTAGE HILL 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: GARY&KAY LOKE Septic Alteration Residential
1 COTTAGE HILL Rd Total Value
QUEENSBUR.Y,NY 12804
Contractor or Builder's Name f Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications .
2002=342
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday;May 02,'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 own Que sb sd May 02,2002
for the Town of ueensbu .
SIGNED BY Q rY
Director of Building&Code Enforcement
519 745- 4437
Y •F i'LE No.638 04zO2 '02.Ail 11:25 •'I D TOWN OF QUEENSBURY FAX:518 745 •4437 PAGE 1
Application for Permit—Septic D;apoSal System
Town of Queettsbury 742 Bay Road Queansbury,NY 12894 (518) 761-8256, .
l. OWNER INFORMATION:• / _.. _ {mice Use .
Location of
IZI(p
installation: f ��
File Permit No.
Tax Map
Fee Paid
Owner's Nama .................:........._._ .__ ._ .__ -- .._
Address:
�yveaof
PHONENO -7�'����6`17
2. INSTALLER S NAME
3. RESIDL7NCE INFORMATION: (circle dwelling,indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total dailyflow)
Year or House- No of Bedrooms Is Computatio oral Daily Flow
1980 or older 2 x 150 gaVbdrnn —
1980—1991 x 130 gal/bdrm = 0
1991 "present x 11 O gaVbdrm �- -
Garbage 0 iuder Installed yes_ / no �AY � % 2002
Spa or Whirlpool Installed yes, / no
SMJRY
4. PARCEL INFORMATION: (circle applicable q)@)MM ter)Q'�}Lj6 r_0DE
. _ hcable inforrnatioa 8c indicate zttaa� F3UI�aD1�����+���GO®�
re
nd, at what depth at what depth c1pa1
Meet feet
pe clay if well;writer supply
pe other from any septic-system
depth: absorption is
other
Percolation Test: (To be completed by licensed professional engineer or arphitect).
Rate: minute per.inch
5. PROPOSED SYSTEM- : All individual sewago disposal systems must be designedby a licensed
profcasional engineer or.architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to tho size
of the septic tank and leach field for each Garbage Chinder,Spa or Whirlpool Tub.
Septic Tom; gallon min. size 1,000 gal.)
Tile Field: each trench / ft Total System Length: f,?�}
SeepagePit(s): number of sizeofeach: A) _ft. by�..J'.
Size of Stone to"be used: # f depth or thickness 2 feet
Bad System Size: x
AlternatiYe gy*Wm; length and/or size .
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: I Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inepection,agency.
7. SIONATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 136 29 of the Code of the Town
of Queonsbury,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 i
circumstance,known by or on behalf of an applicant, shall be void.
I have cad a gulations with re act to this appli ation and agree to abide bythese and all
requir a a Town of Quo� Sanitary swag®Disposal Ord&9tto
signature of respohilbie person
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MAY G ? 2,002
TOWN OFL'rtNSBURY
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"I have seen or observed, or believe I saw evidence of,
all ohi . 3 j1duabouses, wells, trees, fences, etc.,
4. �) r• ; n this documant. I also represent that I have
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perst 1a'(ly n1leasureril J c' distances set forth on the dia arn.,,
SIGNATURE ATE `�-