2001-646 eak TOWN OF QUEENSBURY
BayRoad,Queensbury, 12804-5902 518 761-8201
��� 742 Q �', � )
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010646 Date Issued: Thursday, August 30, 2001
This is to certify that work requested to be done as shown by Permit Number P20010646
has been completed.
Tax Map Number: 523400-301-008-0001-008-000-0000
Location: - 70 HELEN Dr
Owner: COLLEEN PENROSE
Applicant: COLLEEN PENROSE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Ji l' - -
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
` � 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010646 Application Number: A20010646
Tax Map No: 523400-301-008-0001-008-000-0000
Permission is hereby granted to: COLLEEN PENROSE
For property located at: 70 HELEN Dr
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: COLLEEN PENROSE
70 HELEN Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
CONDONS SEPTIC &DRAIN SERVICE
Plans &Specifications
2001-646
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,August 24,2002
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queen:/),s ry; Frid y,August 24,2001
SIGNED BY4 for the Town of Queensbury.
Director of Building ode nforcement
Application for Permit- Septic Disposal System
Town of Qucensbwy 742 Boy Road Queensluy, NY 12804 (518) 761-8256
1, OWNER INFORMATION: •
�o 1/ F�Dig . Office Use
Location of installation: ���` I
File Permit No. l.9—1
Tax Mop No. / / pv
.� Foe Paid ,
Owner's Name:CO/6'6V id e/tai�S �.
Address: A/b 1�44/tl z , C U FF/vl t 0//`r 'Pr
2. INSTALLER'S NAME C t/2)On/S J� � PHONE NO. *-, r'y/6
3. RESIDENCE INFORMATION: (circle year ofdwelling, indicate ll bedroom(.) and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No, of Bedrooms x Compu ration = Total Daily Flow'
1980 or older x 150 gal/bdrm = D 0
1980- 1991 x 130 gal/bdrnl
1991 -present x • 110 gal/bdrm = • E
WED
Garbage Grinder installed yes / no h AUC242001
Spa or Whirlpool Installed yes / no X TOWN OF QUEENSBURY
BUILDING AND CODE
4. PARCEL INFORMATION: (circle applicable information & indicate measurements) '_--... • -. _
IAp9JLtnUhy .oil_►it)I_C9_____. .c1.CVUnd. .ntV1_. _r)omostic_Wgtor,$uppIy
Nat at what depth ctt what depth ' . 021 /=,1
Rolling ocmn /✓! feel /1/� feet wet
Steep slope clay if well, water supply
%slope oilier front any septic-system
depth: absorption is ft.
• oilier
.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 n licensed
professional engineer or architect (unless installed in a Planning i)uatcl approved subdivision), Add 250 gallons to the sii.e
of the septic tank and leach held for each (l:ubagc (►Bider, Spa or With llxml Tub,
An 6115°1
septic Tank:10 - gallon (Wm size 1,000 gal.) RS
i 7�F>L 1.(�1'
Tile Field: each trench 5-6 fl. Total System Length: �. S—o it
Seepage Pit(s): number of size of each: fl. by fT.
Size of Stone to be used: II / cirpt/r or thickness
Bod System Size: x
Alternative System: h u Ti/iA'4 /,LS length and/or size o25 D
6, HOLDING TANK SYSTEM: (if required)
Number of tanks: / Sizo 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 tint pursuant to Section 136-29 of the Code of die Town
of Quoonsbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or failure to take a material fact or
circumstance known by or on behalf of an applicant, shall be void.
I have road the regulations with respect to this application and agree to abide by those and nil
requirements of tho Town of Quecnsbury Sanitary Sewage Disposal Ordinance.
. (-)01\4e4/ — 0/
Signature of responsible person' Date
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road �L'< <00
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name & cr �\0INNi - --J
Location 1 \\2 QQrn - ?'
/6� \D
Date A I,,- Permit #�00t "V�
SOIL TYPE: Sand- oam-Clay- _
Results of '- - olation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench ( '
Depth of trench s ("2,
Size of stone (,.r f w(-?,i Ok 5I4; •
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: .S1ze Type
Bldg. to Tank C--X/sT�(0 11
Tank to Dist. Box S ZJ
Dist. Box to Field/'it'12-051 t(
Openings Sealed? Yes Ri • Partial
LOCATION/SEPARATIO' :
Foundation to Tank / (' feet
Foundation to Absorption 7feet
Separation of Pits 'feet
Conforms as per Plot Plan .es No
LOCATION"O SYSTEM ON PROPER
(circle one
Front - Rear - Left Side - Right Side
Middle F t - Middle Rear
COMMENTS:
•
(2\\\\\
SYSTEM.USE APPROVED: YES NO
Arrived:
Departed: VY)
Building Inspector
C ®LL 't) � KSJ� L (..owl oN S' S 7`"t G "-:,�4'e`a'6 -s-eApLGE°�o�lZ
I
7?I:- s24ul n
Qopf gut/ 'LJ y Ia,s0 if — _ att .'(f( 4-r e ---F r
lir‘ -- TOWN OF
i S .� a `+°
BUILDING & CODE f
REVIEWED BY /��T°
DATE
It c
4 7_G- i - (0-
c� 1— 6 L-/ ,
'4N *
ei
t�tS�'• , AUG 2 4 2001
L26 v fr /) ! TOWN OF QUEENSBURY
4 BUILDING AND CODE
\ � t
,b' AF COPY
E •I..m%=
6(),dj.
"I have seen or observed, or believe I saw evidence
all objects such as houses, wells,trees,fences,etc., of,
L
(�'o,ycrf
11 >✓ shown on this document I also represent that I have
MOO ” personally measured the distances set forth on the diagram."
SIGNATURE DATE