2001-324 FT OWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010324 Date Issued: Thursday, May 24, 2001
This is to certify that work requested to be done as shown by Permit Number P20010324
has been completed.
Tax Map Number: 523400-134-000-0005-019-000-0000
Location: 13 RIVER St
Owner: MATTHEW & JUDY SIMPSON
Applicant: MATTHEW & JUDY SIMPSON
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
�Liajl
x0(1"
Director of Building& Code Enforcement
TOWN OF QUEENSBURY
f 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building & Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20010324 Application Number: A20010324
Fax Map No: 523400-134-000-0005-019-000-0000
Permission is hereby granted to: MATTHEW & JUDY SIMPSON
For property located at: 13 RIVER St
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 fled
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning ��
Ordinance. Type of Construction
Owner Address: MATTHEW &JUDY SIMPSON Septic Alteration Residential
13 RIVER St Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2001-324
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,May 24, 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 T of use >try/ T a May 24,2001
SIGNED BY /� for the Town of Queensbury.
Director of Building&Code Enforcement
•
•
•
. I, OWNER INI'ORMA'I'A11pION
:11tWon for Permit-Septic Disposal System
Mulof Qiieeli,bi7ly 7.12 Boy Rood QJuec shoo:; NNY1280.1 (S18) 761-8256
Locationof installation: ' 3 . A 1 cl eet- Nr, U'fficc Use
Kilo Pot Nod/ ) --ki:'1
Tax Map No. / /
Owner's Name: 4-7-4 e.W c f dtiip�'J J Foe I'aicl 01
Address: /2 k t Li CA-- -S-7 •
2. INSTALLER'S NAME : Ai-0i �we� PIiONE NO
. .7,-f- 7
3, RESIDENCE INFORMATION; (circle year of dwelling, indicate Il bedroom(s) and multiply II of
bedrooms with applicable gallons per bedrubm to equal total daily/low)
• Year of House; • No. of Bedrooms x Compulaliun - Total Daily Flow
1980 or older x 150 gal/bdrnr = cf-a
1980- 1991 x 130 gal/bdrm = _
1991 —present x 110 gal/Willi = - '
Garbage Grinder Installed yes /0 MAY 2'.2 2001
yes
Spa or Whirlpool Installed ��
/ lii✓ TOWN OF OuELNSf3URY
BUILDING AND GO®
4. PARCEL INFORMATION: (circle applicable information & indicate nroasurenrouts) __� .
�1�GOO
.1►V attuo Gt u_i►s Water_ Bedrock or Imps vim's Material 1 _
• GOO .conch crl what depth ,rN u'%url clr�)Nr titer Supply
• a ing 1 4 municipal
vrrnr jeer jeer
Sleep slope clay .
ii slope other
if well; water supply
depth; front any septic-system
absu►pliun is II.
Percolation'Post: (I o be clonrpleled by licensed pro fissional engineer or architect other_
.. laic', 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 inslalled in a Planning hoard al>Inoved subdivision). Add 250 gallons to the size• of the septic lank and leach field for each Garbage Grinder, Spa or Whillpool Tub.
Septic Tank: 1 °OD gallon(min. size 4000 gal.)
'Pilo Field: each french ,SOfi, Total System Length:—0 it
Seepage Pit(s): number of size of each: fi. by it
Size of Stone to be used: it_ ut A.__ / depth or thickness_ ______ jeer
lied System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /'I'0'I'AL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approvecJ
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 Qucensbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or failure to make a material Bret or
circumstance known by or on behalf of an applicant, shall bo void.
I have rend the r•egcrintlons with respect to this npplienllon and ngroo to abide by(hose and all
rcquirorrror f the'Town of Quecusbury Sanitary Sewage Disposal Ordinance.
( Lei, 7d-/ 10/
ign'ature of responsible person-
Uate
C
ll ; 1
TOWN OF QUEENSBURY
BUILDING ; CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name \ ; o '• ¶ M �QS ctv
LocationtiC /3 Iliev-V `l' r,
Date�,J- ;; Apl Permit 1-J�7( '
►✓ I
SOIL TYP a Loam- la
Results of Percolatiin Tes -
(if applicable) Rate Minut:/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To al L- •th
Length of eac trenc M ,.
Depth of trenches
Size of stone firiana '
SEEPAGE PITS: umber
Size - ft. x ft.
Stone size
PIPING: S'3e ype �/�
Bldg. to Tank a l`t7
Tank to Dist. Box ^ 5"-
Dist. Box to Field/P' d S•
Openings Sealed? To Partial
LOCATION/SEPARATII
Foundation to Tank feet
Foundation to Absorption - feet
Separation of Pits feet
Conforms as per Plot Plan - e No
LOCATION : SYSTEM ON PROPERT •
(circle
Front - Left Side - Right Side
Middle ont - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Departed
Departed:
Building Inspector
4
TI
401 RECEIVED
MAY 2 2 2001
rowN OF C•EENSSURV BUILDING HND CODE
W
Jr, < 6 D -
y ®
3
5,0E-tC -igA„Tots-
-
"I have een or nb erved, or believe I saw evidence of, Ieo'
allwile,is S� 'c fences, etc.' TOWN r.c QUEEN RYE.:'.' J TARTMENT
n ,fi r sent(' a ,I tired on our limited exarninatron,
city T" , j (1 - et fo th th ; d torn or C- compliance with our comments shall
.� 7—A,�4 not be constmed as indipting the
c� plans and specifrations are in full
SIGtNATO'E ' p OF compliance with the code ,I
T UrE4SBURY
BUILDING & C
PT.
REVIEWED BY ef
DATE