2001-622 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010622 Date Issued: Wednesday, August 15, 2001
This is to certify that work requested to be done as shown by Permit Number P20010622
has been completed.
Tax Map Number. 523400-295-018-0001-079-000-0000
Location: 102 AVIATION Rd
Owner. MARION & WILLARD STOCKMAN
Applicant: MARION &WILLARD STOCKMAN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
( J,f f
Director of Building&Code nforceinent
TOWN OF QUEENSBURY
`o 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
N
Community Development- Building &Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010622 Application Number. A20010622
Tax Map No: 523400-295-018-0001-079-000-0000
Permission is hereby granted to: MARION&WILLARD STOCKMAN
For property located at: 102 AVIATION 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: MARION&WILLARD STOCKMAN Septic Alteration Residential
102 AVIATION Rd Total Value •
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
JAY SWEET
Plans &Specifications
BP 2001-622
Septic alteration for 3 bedroom house as per plot plan and specifications
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,August 15, 2002
(If a longer period is required, an application for an extension must be made to the code Enforcement
Officer
Dated at the Town e u , 4Ved �, ; • ugust 15, 2001
SIGNED BY ,V Y�r for the Town of Queensbury.
Director of Building&Code Enforcement
•
Application for Permit—Septic Disposal System.
. Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION: 1 -
Location of installation: �f 1 ,. Office Use
: a t2/,: 7�' Q l
�t File Permit No Y�OI p
Tax Map No. �p9j. i / ( /J,�tS-f-��
Owner's Name: / 4.d '' 'e• ' ,
Address: / 0 -)-- Cr U , •`+ 6- j '1
A�G 142001
TOWN OF-
2. INSTALLER'S NAME : BOLD �S13t t�Y
D COD
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multi') 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 = j
1980- 1991 x 130 gal/bdrm = •
1991 -present .x 110 gal/bdrm
•
Garbage Grinder Installed yes—• / .
Spa or Whirlpool Installed yes / no .
•
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
• Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
• Erre at what depth at what depth clrr 1,
—'oiling loam fret feet well "
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
i
• 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 2.50 gallons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank/' gallon (min. size 1,000 gal)
Tile Field: each trench ft. Total System Length: ii.
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 S stem �) r •Y T>/ Y�.--r.r�' length and/or size ,. I'f), >.:/r�4.7 .
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.
• V Y — i ..Y . ro-'? ,
X-k..4.1. --ej .
Sigliat�.tre of. esponsible person . Date •
`TOWN OF QUEENSB Y )� •�BUILDING b CODE ENFORCEMENT
742 Bay Road '}--
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location /0 ‘e01 U
Date. / / Permit # I
SOIL TYP : Sand-Loam-Clay-
Results of Percolation Test-
(if applicabl.e), _Rate-Minute/Inch
TYPE OF SYSTEM: ' `_-
ABSORPTION FIELD: Total, Length y�! ;'r ,
Length of"each trench
Depth of trenches ° •T-
Size of stone Ftcrei{
SEEPAGE PITS: Number-
Size - \ ft. x ft.
Stone size \
PIPING: Size Type
Bldg. to Tank " Lip
Tank to Dist. Mxn� 1\ J(`
Dist. Box to Field,/Pit +,`( -� 10, r70
Openings Sealed? es d No Partial
LOCATION/SEPARAT
Foundation to Tank \ / 7,I, feet •
Foundation to 'Ab sorpt j• ,;on/
Separation of Pi is •,• feet
Conforms as per Plot PlanM No
LOCATION OF SYSTEM ON PROPERTY:
(circle'one) / °
Front - Rear - t Side
Middle Front, - i dd1 g Rears,
COMMENTS:•
SYSTEM•USE APPROVED: ES O
Arrived: \-
Depar
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I REVIEWED BY �� _ _ •
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"I have seen or observed, or believe I saw evidence of, o II c,c4
• all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have 1,--7
—
personally measured the distances set forth on the diagram." -
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SI NATURE DATE ;g/4
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