2001-290 TOWN OF QUEENSBURY
g144..ro 742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010290 Date Issued: Wednesday, May 16, 2001
This is to certify that work requested to be done as shown by Permit Number P20010290
has been completed.
Tax Map Number: 523400-114-000-0009-003-000-0000
Location: 7 QUEENSBURY PI
Owner: CHARLES &KAREN HARRIS
Applicant: CHARLES &KAREN HARRIS
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
t,
Director of Building&Co e En cement
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��� TOWN OF QUEENSBURY
%,70s
742 Bay Road,Queensbury,NY 12804 5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010290 Application Number: A20010290
Tax Map No: 523400-114-000-0009-003-000-0000
Permission is hereby granted to: CHARLES &KAREN HARRIS
For property located at: 7 BENTLEY P1
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: CHARLES &KAREN HARRIS Septic Alteration Residential
7 QUEENSBURY P1 Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
CONDON SEPTIC & DRAIN SERVICE
Plans & Specifications
2000-290
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,May 14,2003
(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 " to ensb ; VIon ,,► ay 14,2001
•
SIGNED BY c -`A for the Town of Queensbury.
Director of Building&Code Enforcement
-4 Application for Permit—Septic Disposal System
Town of Queettsb2tt y 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
fir. . .
�' "�-*"9 "since Use 1
Location of installation: y,"/ MA r
Tax Map No. / / 1'O� q�l
bile Wiffi No. (QJ�9V
Owner's Name: ,� - ..„.- ,,D
Address:/3 A604) PAS a J •
2. INSTALLER'S NAME(104 J/Y S, r ,oG, 'Ai 6 `,.,./fse*, PHONE NO. .gr��r
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# 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 3 x 150 gal/bdrm = x/10
':0- 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes /
`
Spa or Whirlpool Installed yes / .
4. PARCEL INFORMATION: -(circle applicable information&indicate measurements)
T.L.graphs' Soil ature Ground Water Bedrock or Im ervious Material Domestic ater Su 1
Fla sand aj what depth at wh t depth unici�l
'oiling oam �1' feet 41 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.
Septic Tank: yt 1.,, • gallon min. size 1,000 gal.)
Tile Field: each trench jr 0 ft. Total System Length: Q ft.J4'A/7 471�/5
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
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 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 Ordinance.
ti
V_p _cl/d r---a/
gnature of responsible person Date
TOWN OF QUEENSBURY iv"
BUILDING&CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
/> /frJ-5
Nameij ril 5
Location
Date ' / / Permit - �C,
SOIL TYPE• San oam-Clay-
Results of Per{ol .tion Test-
(if applicable) Ra ' --Minute/Inch
TYPE OF SYSTE
ABSORPTION FIE D: Total Lengthia d
Length of each trench i 501--
Depth of trench s/ `J
Size of stone . \/Av / 7 7" )/�
SEEPAGE PITS: N .er-
Size - f . x ft.
Stone size
PIPING: -� ize Type
Bldg. to TankK/5i/�
Tank. to Dist. Box 4/ X - C)
Dist. Box to Field/' ' i1
Openings Sealed? &Y-: No Partial
LOCATION/SEPARATION•
Foundation to Tank feet
Foundation to Absorpt'on U feet
Separation of Pits _ feet . •
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON '"ROPERTY: .
(circle one)
Front - Rear - ft S ' - Right Side
Middle Front - Middle R-ar
COMMENTS:
SYSTEM USE APPROVED: YE NO
Arrived: . - /
Departed: t7
• St.7)!,
Building Inspector
lv ` �
O "I have seen or observed, or believe I saw evidence of,
all objects such as houses,wells,trees,fences, etc.,
V �.I shown on this document I also represent that I have a e;
`� Personally measured the distances set forth on the diagram."
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SIGNATURE DATE
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