2001-241 Atn TOWN OF QUEENSBURY
-o-o"or
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010241 Date Issued: Monday, May 07, 2001
This is to certify that work requested to be done as shown by Permit Number P20010241
has been completed.
Tax Map Number: 523400-309-009-0001-033-000-0000
Location: • 213 LUZERNE Rd
Owner: LOUIS & MARILYN GUILES
Applicant: LOUIS &MARILYN GUILES
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building& Code nforcement
•
TOWN OF QUEENSBURY
virs 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010241 Application Number: A20010241
Tax Map No: 523400-127-000-0003-002-000-0000
Permission is hereby granted to: LOUIS & MARILYN GUILES
For property located at: 213 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
Ordinance. Type of Construction Value
Owner Address: LOUIS &MARILYN GUILES Septic Alteration Residential
213 LUZERNE Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
'
Plans &Specifications
2001-241
SEPTIC ALTERATION AS PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Sunday,May 04,2003
(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 Queens ury; Fri ay May 04,2001
SIGNED BY for the Town of Queensbury.
Director of Building Code nforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: 07.13 6 Pr> I
File Permit N )O—c 1/
Tax Ma p No. / / 1
• Fee Paid
Owner's Name: _ -o
Address: .2/3 gj
� •
2. INSTALLER'S NAME : �` , �; PHONE NO. 9972210
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 -7of er x 150 gal/bdrm = 30
1980— 1V91 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes / no X RECPPVE#
Spa or Whirlpool Installed • yes / no >c MAY 0 3 2001
TOWN OF C, uet:i1a� Y
; t1
4. PARCEL INFORMATION: (circle applicable information &indicate measuremen flJILDii;GAP &s°L1
,po
TopographySoil Na ure Ground Water Bedrock or Impervious Material Domestic Water Supply
firESO ("sand at what depth at what depth municipal
Rolling loam feet feet wel.
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: /t 0J0 gallon (min. size 1,000 gal)
Tile Field: each trench y-- ft. Total System Length: /3v ft,
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: ft / depth or thickness i q" 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.
Signature ''responsible person Date
'W7) .
X .) 6 )
k. 9.i." TOWN OF QUEENSBURY
BUILDING_& CODE ENFORCEMENT --c:) 10/1)
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ) () ( tc1uW
Location "� 1 ►�Zx�„ ,„ ,��--��
Date- -,..)C()) Permit #r (-04 ",
SOIL TYP Sand- oam-Clay-
Results of Percolation Test-
(if applicable) Rat -Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: tal ngth r _
Length of each tren h , 0 _1.-7
Depth of trenches 7 r •- 7,'
Size of stone #
SEEPAGE PITS: Number-
Size - ft. x 't.
Stone size
PIPING: S - e Type
Bldg. to Tank E z - • C3-r,, `i" .kyi
Tank to Dist. Box 4" ' v ,.
Dist. Box to Field/Pit i--P' C ' F-
Openings Sealed? No . : artial
LOCATION/SEPARAT
Foundation to Tank . t
Foundation to Absorption 475 -t-fe. .
Separation of Pits fee.
Conforms as per Plot Plan 0
LOCATION OF SYSTEM ON PROPERT .
(circle one)
Front £Rear Left Side - Right Side j
Middle f•ronf Middle Rear
COMMENTS:
tom c .. -ice ��K-( L
•
SYSTEM.USE APPROVED: 4101110 NO
Arrived.:--)l 60
Dep r ied://- fo
/,- . Bildi gI specor
l
have seen or observed,or believe I saw evidence of,
al objects such as houses, wells,trees,fences, etc.,
s own on this document. I also represent that I have
6. p•rson. . ii•asured the dista es set forth on the diagram."
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9 . 5 l
SIGNATUR DATE
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