2001-198 TOWN OF QUEENSBURY
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2 Ba Road ueensb NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010198 Date Issued: Thursday, April 26, 2001
This is to certify that work requested to be done as shown by Permit Number P20010198
has been completed. -
Tax Map Number: 523400-101-000-0005-016-000-0000
Location: 31 PARK VIEW Ave
Owner: KENDALL &MARCIA JOHNSON
Applicant: KENDALL &MARCIA JOHNSON
This structure may be occupied as a:.
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
QQ a ,
Director Building& Cod< Enfo -ment
TOWN OF QUEENSBURY
4y` - 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010198 Application Number: A20010198
Tax Map No: 523400-101-000-0005-016-000-0000
Permission is hereby granted to: KENDALL &MARCIA JOHNSON
For property located at: 31 PARK VIEW Ave
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: KENDALL &MARCIA JOHNSON Septic Alteration Residential
31 PARKVIEW Ave Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2001-198
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,April 25,2003
(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 To o eens ; Wee +e i ay,April 25,2001
SIGNED BY 7 for the Town of Queensbury.
Director of Building&Code Enforcement
Owner's Name: � p1 !� �(�`` t) ji • ee Paid '
Address: 11)62.-4,—/e, LI t P ))
2. INSTALLER'S NAME : Op_eivuslju PHONE NO. ' /— Ogg/
3. RESIDENCE INFORMATION: (circle year of dwell , indicate#bedroom(s) and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980,or older x . 5( gal/bdnn = -'U
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes— / o q�
Spa or Whirlpool Installed yes / n fC
APR .2 5 2001
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
OWN OF OUEENSBUR'Y
BUILDIN ,ANDCOE
Topography Soil Nature Ground Water Bedrock or Impervious Material—mr o. Water apply
Flat at what depth at what depth munici
Rolling loam feet feet well
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption 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 licensed
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.
kg
Septic Tank; o e)gallon (min. size 1,000 gal)
Tile Field: each trench ft. Total System Length: ft.
Seepage Pit(s): number of size of each: ft by ft.
Size of Stone to be used: II / depth or thickness feet
Bed System Size: x
• Alternative System: (3-te, 1J 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 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 Ordinanc .
Sigrrtu e o resp nsible person Date
/O:
TOWN OF QUEENSBURY
BUILDING'& CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 34;604)
Location , AROW
Date 24 O 1 Permit # OP- /9U
SOIL TYPE Sand- oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch__
TYPE OF SYSTEM:
ABSORPTION FIELD: Tot. - gtfy , GO -
Length of each trench
Depth of trenches
Size of stone C L t Z Z s
SEEPAGE PITS: Numb_r-_
Size - ft. ft.
Stone size
PIPING: 7 Size Type
Bldg. to Tank - „Size
Tank to Dist. Bo) !'v;, 541-t�14)
Dist. Box to Fi el &/Pi 'r D
Openings Sealed? es No Partial
. LOCATION/SEPARATIIN
Foundation to Ta k . feet
Foundation to Ab.orption - feet
Separation of Pi s feet
Conforms as per 'lot Plan Oil) No
LOCATION OF SYSTEM ON PROPERT .
(circl . on
Front Rea - - eft Side - Right Side
Middle F t - ` fiddle Rear
COMMENTS: .
•
•
SYSTEM.USE APPROVED: • I YES NO
Arrived:
r,
Departed: p
Building Inspector
.717 . .
06 /7 /1 '
•
APR 2 5 2001
1 ---- -0. TOWN OF QUEENSBURY
BUILDING A_ND CODE
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"I have seen or observed, or believe I saw evidence of, r.-
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all objects such as houses, wells, trees,fences, etc.,
shown on this document.1 also represent that I have 1
personally measured the distances set forth on the diagram."
SIGNATURE ( ' • LATE
TOWN OF QUEENSBURY
BUILDING & iiii, P .
TOUiliV Qr QUEENS °• 74 it ('NG n :.
used on our limited examination,
i Pr1CNT REVIEWED
compliance-with our comments shall DATE Z' 6
not be construed as indicating the •
plans and specifications are in full
compliance with the code