2001-612 010. TOWN OF QUEENSBURY
Foro742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number:. P20010612 Date Issued: Tuesday, August 14, 2001
This is to certify that work requested to be done as shown by Permit Number P20010612
has been completed.
Tax Map Number: 523400-308-018-0002-057-000-0000
Location: 597 CORINTH Rd
Owner: CHESTER M. BASSETT JR
Applicant: CHESTER M. BASSETT JR
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
d
Director of Building&Code Enforcement
' TOWN OF QUEENSBURY
` 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
, Ir/4,74,1
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
1
Permit Number: P20010612 Application Number: A2001.0612
Tax Map No: 523400-308-018-0002-057-000-0000
Permission is hereby granted to: CHESTER M. BASSETT JR
For property located at: 597 CORINTH 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: CHESTER M. BASSETT JR Septic Alteration Residential
597 CORINTH Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
SIGNORELLI & SON
589 WEST MOUNTAIN ROAD
OUEENSBURY,NY
Plans &Specifications
2001-612
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,August 10,2002
(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 of ee sb • rida ,August 10,2001
..
SIGNED BY r for the Town of Queensbury.
Director of Building&Code Enforcement
s
2, •' ;
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-825 a
1. OWNER INFORMATION:
5---7 ��/�t//�/ , ¢�f Office Use
Location of installation:
File Permit No..; :ed Cll l
Tax Map No. / /
•Owner's Name: eh,s7,-�
Fee Paid �.� G
Address: S 9 . 4-,e/<v/21
2. INSTALLER'S NAME : y/ --r/f IUOIQ PHONE NO. 7 —4 e
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. = 3 0-e
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm
Garbage Grinder Installed yes_ E no_
Spa or Whirlpool Installed yes— o� RECEIVED
4. PARCEL INFORMATION: (circle applicable information &indicate measuren, 0)0 9 2001
a S ure Ground Water Bedrock or Im erviouMithriaElQUEMM YWater Supply
Fla sand at what depth at what depth
Rolling loam feet feet e .
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 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 250 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 l ft. Total System Length: /c:72' f.
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
y g �`���6r— �cJsr�
Alternative S em: length and/or size
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.
Si nat a of re onsibleperson Date
a 1 / VV
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name &3?f77---
Location 77 C�i//u%/a 49.
Date (S //V/l:I/ Permit # di re/ -
/ 0
SOIL TYPE: Spa_fr{d-L.am-C .y-
Results of Percola, ion Te .t-
(if applicable) Ra ,e-Minu .e/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tital en thl JZ&
Length of each trench L2_
Depth of trenche
Size of stone j ffi.
SEEPAGE PITS: Numbe -
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box • 540
Dist. Box to Field/' 1 1' 0
Openings Sealed? e No Partial
LOCATION/SEPARATIONS1
Foundation to Tank eet
Foundation to Absorption ' '3 feet . .
Separation of Pits I eet
Conforms as. per Pl ot1 Plan Yes No
5
LOCATION OF SYSTEM ON PROPERT :
(circle 6 )�
Front -(Rear - Left Side - Right Side
Middle Fro fit - Middle Rear
COMMENTS:
1/CGJ !
•
SYSTEM USE APPROVED: O
NO
Arrived: `
Departed:
,„\g:_,----------
Building Inspector
lila
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road sr3 pm
Queensbury NY 12804
(518) 761-8256 rAcma
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ��t\ /A/17' e
6:-
Locationrj 79 0Y 1 /\ - ej
Date - -or i( ermi t # 0a -(p
SOIL TYPE: an•- oam-Clay-
Results of '-rcola 'on Test-
(if applicable) Rae- inute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches \,
Size of stone ,/1
SEEPAGE PITS: Number;,
Size - -f- x \ ft.
Stone size \
PIPING: \4 'Si e TypeBldg. to TankO
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank l "j_ feet
Foundation to Absorption . _ feet . .
Separation of Pits -_ feet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPER •
(circle
Front Re. - Left Side - Right Side
Middle -ront - Middle Rear
COMMENTS:
lf9A)re" Obi —eV.
SYSTEM.USE APPROVED: YES NO
Arrived: r_79Z
Departed:
cigc
Building Inspector
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SUP DIN1G q ,--, . R , .,,,
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REVIEWED BY Q 0
DATE r��i .._ ��' , om
J)I • �� I
33_ r
"I a ve seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences,etc.,
11 r--_�
shown on this document.I also represent that I have u
personally measured the distant set forth on the diagram."
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U RE DATE
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