2001-299 0111" TOWN OF QUEENSBURY
Bay 742 Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010299 Date Issued: Tuesday, May 15, 2001
This is to certify that work requested to be done as shown by Permit Number P20010299
has been completed.
Tax Map Number: 523400-101-000-0007-004-000-0000
Location: 32 PARK P1
Owner: RICHARD T OST
Applicant: RICHARD T OST
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
t
—3a4119/1 .
Director of Building&Code Enforcement
��� TOWN OF QUEENSBURY
`k 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010299 Application Number: A20010299
Tax Map No: 523400-101-000-0007-004-000-0000
Permission is hereby granted to: RICHARD T OST
For property located at: 32 PARK 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: RICHARD T OST Septic Alteration Residential
32 PARK P1 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
2001-299
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,May 15,2003
(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 th= expiration d.te.)
•
Dated at the To of en "41 T,e: x.. ;1 ay 15,2001
SIGNED BY 1 for the Town of Queensbury.
Director of Building&Code Enforcement
•
Application for Permit—Septic Disposal System
Town of Q11een sb,I y 7•12 Bay Rum!Qliee►Isbur►', NY 12804 (S I8) 761-8256
if 1.' OWNER INFORMATION: .
Location of installation: '3r ve3L.)-e r Office-Use
rra " Tax Map No. / / Kilo Peiniit No. U 1—� 11
Owner's Name: 1 C-11744 7) 0 ,S.-7
tree Paid .--D.S- Od
AdL Address: 2p� � � 4cE •
2. INSTALLER'S NAME : AV L'e rE4_.„e _`7 (� v PHONE NO,7 9� a-7,1- f 7
3, RESIDENCE INFORMATION; (circle year of dwelling, indicate ll bedroom(s) and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House; No. of Bedrooms x 1►
(,o�h tilgiuu - Total Daily Flow
1980 or older ,g x 150 gal/trdrnt = rGM
1980— 1991 x 130 gal/bchm =
1991 --present x 110 gal/bdrnl = " � '� .°
Garbage Grinder Installed yE5 /c mAY 1.4 2001
Spa or Whirlpool Installed yes / _ T0N OF 0 ;�S€3tJF�
BUILDING t\iat3 C'ODE
T
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
,rarrily Soil. u 'o (3 r mu lid Writer_ Bedrock or_Immmpeivio us MatetiaJ_
Ilvl!lnl; or r at what( /N/r rrI What rlr!/rf/r i. rrrr ri W'��er lrt�ly
feet fret wee! •
Steep slope clay
slope other if'well; water supply
depth: from any septic-system
absoipilon is fi.
•
other •
Percolation'Pest: (To be completed by licensed pro fi.'ssiona!engineer or architect) _ _______
•
Rate: minute per inch
5. PROPOSED SYSTEM: Fur New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Hoard appiovcd subdivision). Add 250 gallons to the sii.e• of the septic lank and leach field for each Garbage Grinder,Spa or With(pool Tub.
Septic Tank: ION gallon (min, size 4000 gal)
Tile Mold: each trench ft. Total System Length: -OJ it
Seepage Pit(s): number of size ()fetich: fl. by fl.
Sizo of Stone to bo used: iii__I-1 f}' — / depth or thickness._ .__.__ _fret
Bed System Size: x
Alternative System: length and/or size
G. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /'I'O'1'AL, 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 tiro'Town
of Quecnsbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or failure lo make a male'IaI tact or
circumstance known by or on behalf ofan applicant, shall be void.
. I have road regulations willt roved.to this nlrplicallon and agrce lo abide by These and all
t•equirom tits o io'I'own of Quecnsbury Sanitary Sewage Disposal Ordinance.
�l
Sign _cure of res able •
port perso Date
TOWN OF QUEENSBURY
--�—`' BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name : �r ,r�) 0•SA • •
Location3; pavl( PICtcQ.
Date 5 - At Permit # O c.9`)
SOIL TYPE: ',and- oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Le gt)1 6;7- _
Length of each trench r.
Depth of trenches Z
Size of stone ,/�,ri6 l3jOdQ
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: S'.ze Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/P. . —T
Openings Sealed? No . :Partial
LOCATION/SEPARATION .
Foundation -to Tank d feet •
Foundation to Absorption . feet
Separation of Pits et
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERT
(circle one) •
Front - Rear - Left Side - ight Side
Middle Front - Middle Rear
COMMENTS: : .
•
•
SYSTEM.USE APPROVED: YES2 ) NO
Arrived: . •
Departed: Ona
JPV-
. Building Inspector
.,,,Q,g0 i -O-9
rii, C � '
.E
MAY 14 2001
TOWN OF QUEE+ `s■
BUILDING AND 1 ODE.
(� L
l"�
M
57,
! C41
:t"I have seen or observed, or believe I saw evidence of, '� ,A
all objects such as houses, wells, trees, fences, etc. '' -
1 on this document. I also represent that I have
pie soi ally measure h istanc et forth on the diagram." ' -- r
:,...-6/6
'IG —DATE 'k
V
TOWN Cyr QUEENSBURY C UlLDlNG DEPARTMENT A
Based on our limited examination,
compliance with our comments shall
not be construed as indicating the
plans and specifications are in full
compliance with the code.
TOWN OF QUEENS RECOPY
BUILDING & c D `
REVIEWEDr
DATE
V