2002-734 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761.8256
ATCOMPLIANCECE�T IFIC E F�
Permit Number: P20.020734 Date Issued: Thursday, September 12,2002
This is to certii£y that work requested to be done as shown by Permit Number P20020734
has been completed.
Tax Map Number: 523400-302-018.0002-043.000-0000
Location: 24 SEWARD St
Owner: TIMOTHY&STELLA COFFEY
Applicant: TIMOTHY&STELLA COFFEY
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
f 742 Bay Road,Queensbury,NY 12504-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020734 Application Number: A20020734
Tax Map No: 523400-302-018-0002-043-000-0000
Permission is hereby granted to: TIMOTHY& STFLLA COFFF,Y
For property located at: 24. SEWARD 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 filed
and approved and:in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: TIMOTHY& STELLA COFFEY
24 SEWARD St Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
ROI LTN GRAVES FXCAVATTNO
Plans&Specifications
2002-734
Residential septic alteration per plot plan and specifications.
$25,00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 30,2003
(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 n o ueens ry; i ,August 30,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application.for Permit—Septic QisposallSyste
Town ofQueensbury'742 Bay Road Queensbury,NY 12804 qlj -8256
1. OWNER INFORMATION: AU C '
_.......................... _...................._........_._
cS G( �-f" OWN OF
Office Use
Location of installation: P�,x Y MI 11.�,. .1s.1_ �f-- 62-- 1f
30� . �� ? n File Permit No.
�8 ___.._
Tax Map No. -- / ! J' _ -1 �y i'O 'l��-'
/ Fee Paid
llr``Owner *l�s Name: '' o �.N ......................................................_................ ... ._.._..._.........._.........._......._
Address: _ - e �� `y /u 5 /� o Ct
t{ �A 5'-f- �c.L�..s�s u .
INSTALLER'S NAME : go((", K(ZA As L�cc�Atrl�7-l.�l� PHONE NO. 34 1-b Y 1 S
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/bdrtn =
1980— 1991 —�— x 130 gal/bdrm =
1991 —present E -- x 110 gallbdrm = cI
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes— / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
TovograDhv Soil Nature Ground Water Bedrock or Inigervious Material Domestic Water.Suioolv
san at what depth at what depth municipal
Rolling oam feet - feet we
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 Constrack;2n: 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: !LS"G7 gallon(min. size 1,000 gal.)
Tile Field: each trench -Ella ft. Total System Length: / zI f?,
Seepage Pit(s): number of size of each: t. by -t.
Size of Stone to be used: # l depth or thickness feet
Bed System Size: x
Alternative System: length andlor size -
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: 1 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 ofthe 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.
Si nature of respons.ib a per o Date
_ 'fawn <)f (2ucenat)ury '
' :�t�tivt'r:; :trot �ic:w:iPc: I)i:.i).c):; t1,t.li:Jt)it•r-
AI)IwittI1!C C
fit;;IIARA'I'ION Itt�;(2l.!Ilti,ltill�'.{V'I`;i
' � St'FiEPcM •�_
t O l
�J" �"r�lL UJ I/ATF.'.FZ• !� WI:1 tt'�t..t
--� : 5q t.t Ic..
E`tAt-b:
RAUND
7. SIGNATURE &INFORMATION FORRESYtJrtWOL.r-
tr>✓>wvs� �,.vs+��••,..•f
OF QUEEKSBURY
BUXI-DING &---CODE ENFORCENEWT
74Z Ba_y R"Ma
MY :12804
SEPTIC DISPOSAL... SYSTEM INSPECTION
Name
Loca-tion
Da-t e- 711;7-7/1 - P e r-m 1 -t
SOIL TYPE: San Loam-Cl a_y-
Resul -ts of v-cc:)1a -t1on Test-
( 1 -F applicable ) Ra -tte--Minu-ta/Inch
TYPE OF SYS"TEMz
ABSORPTION FXEID: To-tal Length
each trench
Leng�th of
Depth of trenches
Size O-F Stone A IQ Lsi-N
SEEPAGE PITS : Numt>e_ i--
x
Stone size
PIPING: S -1 Z: 6 Type
BI dg . to Tank
--V\ 1AC>
Tank- -to Dis-t - Box t A CIXA )ZN-r-7>
Dis-t . Box to Fie-ld/p -
OP e-n 1 n g s Seal t--- d ? a No Pai-tial
L_OcAY11cmN,/sEPARA-rro s :
Founda-tion to Tank x -feet
Founda -tion to Absorp -tia
Sepava -tion of Pit--s fe
Conforms as per P1 c)-t P an Yes
LOCATION OF SYSTEM PE Y:
( ci r-cl e
Fi-on ft- - Rea q-f-t lde S i d e
Mi ddl e M-1
COMMENTS
SYSYEM USE APPROVED= YES NO
A irir-1%pta-cl
0 S
D t--P a % J/- -
61 i--r ntr n np k--C_-7tCP
..:::.:.... .. . ::.. . . ...
VS
cci4tss 4 �� r �3. .. .:...,:' : •r:,, ,,1.......,•.:.:. :. r�c �c '- :"
.. . .. . ............... ... .. ... ... e .. ..
.... .........
4
.... .... ... ..
. .... ...... .. .. ............. .. ............... . :
.....
: .
:.:::cci:r:
..... ......... ..............::::.. . :
:i.
U
.r "1.
... . .. ..........
!{.
.. ... •may!::::.!; ....•:.•L..:...•.
..... BURY
:•.•;:.::..• •:..r.. •••::•:•:.::�:.:.j:•4SS::j:,jar: • �h•
•✓ yg �(.:?�
jjfw {�':{
... ..�. ...:�%:u--• •';•.;! -.; •-'- /wry
k
. .. .::.•
O4 � r�.j •�s'3
...•.
.............
... ... ..... ....
..............d. ... .......... ....5:
�.,. .
l
4.. . . . ... ......:: .
1•
-'S!
1 / ' [[
..5. - _
:V '
: .:
{x• __
:1-
'....
a
..
:;•:
r
r
::
N
i
T
...... ................................ ........
........ .. ....... .....................:........................ ...................:.............. .
.............:.....:....... ......
.... ... ...............
ter.}u lLGWflrA
shall
cor^�iiarj vnth out romm°
e construed ath
s tindica tn9
r ar}n specifications are in full
unsde.
f2};c...