2002-864 t'
TOWN OF QUEENSBURY
742 Bay Road,Queeasbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE,
Permit Number: P20020864 Date Issued:, Wednesday, October 16,2002
This is to certify that work requested to be done as shown by Permit Number P20020864
has been completed.
Tax Map Number; 523400-301-007-0001-054-000-0000
Location: :25 BUENA VISTA Ave
Owner. DAVID&CYNTHIA MARION
Applicant; DAVID&CYNTIIIA MARION
This structure may be occupied as a:
By Order,of Town Board
Septic Alteration Residential TOWN of QUEENSBURY
`P
1
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: P20020864 Application Number: A20020864
Tax Map No: 523400-301-007-0001-054-000-0000
Permission is hereby granted to: DAVID & CYNT14TA MARION
For property located at. 25 BUENA VISTA Ave .
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. Tune of Construction Value
Owner Address: DAVID & CYNTHIA MARION Septic Alteration Residential
25 BUENA VISTA Ave Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
01 JEFNSBT JRY.NEW YORK
Plans&Specifications
2002-864
Residential septic alteration per plot plan and specifications.
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, October 16,2003
(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 Tow October 16,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
71oivii of Qiieeilsbwy 742BqyRoadQueeiis15t"-
V, NJ' 12804 (518) 761-8256
1. OWNER INFORMATION:
..................................................................................................I............................
Location of installation: Office Use
Tax Map No. File Porujit No.
Owner's Name: cD Fee Paid V E
.........................................................................................................
Address: OCT 1 5 2002
2. TO"�r� OF- i-
INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION:* (circle year of dwelling, indicate #beodrooni(,V) and multiply
bedrooms with applicable gallons per bedroom to equal total dailyfloll')
Year of I-louse:.. No. of Bedrooms x Computation = Total Dai
ly Clow_
1980 or older x 150 gal/bdi-in =
1980- 1991 x 130 gal/bdrin =
1991 -present x 110gal/bdrin =
Garbage Grinder Installed yes / 110
Spa or Whirlpool Installed yes_ Y I no
4. PARCEL INFORMATION: (circle applicable inforination &indicate ineasurcluents)
"Core --Qk-QP-1Ld—WP-tS!K-
U&I-tj 4 Material- D Water S ily
I a 11allc ep C��epth
X 1/1 it if tirruricipal
lhig -knil-11 et
,AAt-jil
Steel.)slope clay if ivell; water supply
slope other
fi-0111(bly septic-.system
depth: absoiption is
Other
Percolation Test: (To be eampleted by licensed pre yessional engineer or architect)
Rate: 111111111c,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 Planning 13oardal-q)roved subdivision). Add 250 gallons to the size
of the septic tank and Icach lield for cach Garbage(kinder, Spa or Whirlpool Tub.
1 " / t,, A-- %--)
Septic Tank: ako al on size 1,000 gal.)
Tile Field: each it-encli_jj. TOL-11 System Length:---Jt.
Seepage Pit(s): number of--D-- size of each: fl. by
Size of Stone to be used: #- 3 or thickness feet
Bed System Size: x
Alternative System: 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 noto that pursuant to Section 136-29 of dio Code of the Town
of Qucensbury, any permit or approval granted which is based tipoti or is granted in
reliance upon any material misrepresentation or failure to ni.-ikc a material fact or
circumstance kuowa-by or on-belialf of-.in applicant, shall be void.
I have read the regul'atiofis with respect to this application and agree to abide by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
gnature of responsible person Date
y
TOWN OF QUEEMSBURY
BUILDING_ A-CODE ENFORCEMENT
742 Bji_y R"c-Rcf
12004
(518) 761-82-56
SEPTIC DISPOSAU SYSTEM XNSPEC-rIOM
N am t-- <-,:):) - tr X-1—
L o c--a -t 1 on _Ae-,v I/
Date Permit W
SOIL -TYPE: San - Loam-Clay-
Resul -ts 0-F Pe_ r-cola-t-lon Te-s-t-
( 1 -F applicable ) Ra-to-mlnu-te_/Inch
-TYPE OF SYSTEMz
ABSORPTYCW4 FIEUD : Total Length
Length 0-f each trench
Depth of"' trenches
Size o-f S-tone
SEEPAGE Py-T-4-- : N umb e r--
S1z,e_ - -F-t - x — -Ft_
S -tone size z;W= �
PIPING: Size Type
B l d g . -to 71ank
Tank- to Dist - Box Ic
Di st-- . Box to Fi el d/Pi -t— z.
openings Sta-aled ? . (�� No PartialL_OCA_F11OM,/SEPARATrON!5
Founda-tion to Tank
-feet
Founda-tion -to Absoi-p -t-lon d- -Feet
Separation of Pits feet
Conforms as pet- Plo-t Plan 7 es No
ON OF SYm O "TY
n PROPER :
t_OCATI S"TE
e- one )
Rear- - LeV-t Side - Right- Side
F t-on -t - Middle Rear
COMMEWTS z
SYSTEM USE APPROVED = YES No
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