2001-340 -0� TOWN OF OUEENSBURY
31 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010340 Date Issued: Thursday, May 31, 2001
This is to certify that work requested to be done as shown by Permit Number P20010340
has been completed.
Tax Map Number: 523400-082-000-0006-039-000-0000
Location: 22 CROWNWOOD Ln
Owner: SHAWN & JILL LITTRELL
Applicant: SHAWN & JILL LITTRELL
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY t
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
FIrria 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010340 Application Number: A20010340
Tax Map No: 523400-082-000-0006-039-000-0000
Permission is hereby granted to: SHAWN&JILL LITTRELL
For property located at 22 CROWNWOOD Ln
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: SHAWN & JILL LITTRELL Septic Alteration Residential
22 CROWNWOOD Ln
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2001-340
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 31,2003
(If a bnger period is requited,an application for an extension must be made to the code Enforcement Officer
of the Town of Queenabury before the expiration date.)
Dated at the Tow/ro eens Th •;� u :y 31,2001
//)
SIGNED BY �� � for the Town of Queensbury.
Director of Building& Code Enforcement
Application for Permit—Septic Disposal System
Town of Queens/my 742 Bay Road Queensbury, NY 12804 (518) 761-8256
• 1. OWNER INFORMATION:
Office Use
Location of installation: ,.,2 2 e r k-)A4,w O ) 1
File Permit b No.Q801-311
Tax Map No. / /
� 00
P� 4 •
Fee Paid4J
Owner's Name: SVl'ttJ ev 4 S , ‘ k t T-I-Ire. ( (
Address: a e-rEN.A.)N us-0-0 c
2. INSTALLER'S NAME : O� P e%� • . e—ir PHONE NO.7 ( 4776. 96(
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 x 150 gal/bdrm =
1980— 1991 ) 130 gal/bdrm = :j cf O seGF NED
1991 —present x 110 gal/bdrm = i •
Garbage Grinder Installed yes / no ,•
MAY 2 9 2001
Spa or Whirlpool Installed ' yes / no ; 3 OV�lN OF CCU�c•
63UI�DII�Ita F+NC3 71.2.1Y
•
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Dom stic Water Suppjy.
Cr7` s at what depth at what depth nuniclpal-
Rolling loam feet feet we
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
•
other
Percolation Test: . ( o 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 subdivisions). Add 250 gallons to the:size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: /c o z) gallon (min. size 1,000 gal.)
Tile Field: each trench v - 4 d ft. Total System Length: ;5-0 ft.
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:I t ( f t ci `f'r- S length and/or size C) • •p (rp kwl
•
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.
xi, .
—_ P
Signatu e o responsible person Date
\\ A411\
TOW OF QUEENSBURY
• BUILDING & CODE ENFORCEMENT CC.p
742 Bay Road lV�
Queensbury NY12804�
(518)761-8256
(-
SEPTIC DISPOSAL SYSTEM
INSPECTIONI
Name �I 'Ul>J 51^^4-. 1i LL ) -�YP,I
Location O_ \ 'NG ATYNI `'X' ) u
Date S' 3()-o2jj� ! Permit 8 legt°
SOIL TY ' Sand-L' C1ay-
Results of Percolation Test- s \
(if applicable) Rate-Minute/Inch el
TYPE OF SYSTEM: —I41
ABSORPTION FIELD: Tot. k-ngth !-,�•�1 �
Length of each trench c. :,• - 3D
Depth of trenches
Size of stone 1'dR1 1-,: .
SEEPAGE PITS: umber-11W
Size - ft. x t.
Stone size Pr
PIPING: ize ype
Bldg. to Tank "
Tank to Dist. Box
Dist. Box to Field/Pi _ 1„
Openings Sealed? Vim► 'o 'artia
LOCATION/SEPARATION :
Foundation to Tank F1ST" feet
Foundation to Absorptio 70 feet
Separation of Pits feet
Conforms as per Plot Pla CYes o _
LOCATION OF SYSTEM ON P',SPERI :
(circle one)
Front - Rear - Left ' - ight Side
Middle Front iddle Rear
COMMENTS:
RLL_ \a‘ bg Pt-oMa\i3CG
c1/4-1/41a AF-cD 1/40 W the
SYSTEM USE APPROY • NO
Arrived:
Depa
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TOWN OF QUEENSBURY
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