2002-983 TOWN OF QUEENSBURY
742 Bay Road,Queensbuty,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE..
Permit Number: P20020983 - Date Issued: Monday, December 02,2002
This is to certify that work requested to be done as shown by Permit Number P20020983
has been completed,
Tax Map Number: 523400-295-014-0002-075-000-0000
Location: 20 DORSET,PI
Owner: THOMAS&MARIE MILES CONGALOSI
Applicant: THOMAS&MARIE MILES CONGALOSI
This structure may be occupied as a:
By Order of Town Boatd
Septic Alteration Residential TOWN OF QUEENSBURY
�t
Director of Building&Code Enforcement
TOWN OF,QUEENSBURY.
742 Say Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020983 Application Number: A20020983
Tax Map No: 523400-295-014-0002-075-000-0000
Permission is hereby granted to: THOMAS &MARIE MILF,S CONCiALOSI
For property located at: 20 DORSET Pl
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. Tvue of Construction Value
Owner Address: THOMAS &MAR.IE MILES CONG
20 DORSET PI Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Oi JFF,NSBI JRY SEWER
JAY SWEET
Plans&Specifications
2002-983
Residential septic alteration per plot plan and specifications.
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 29,2003
(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 ,,of Qu nsbu F a tuber 29,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit Septic Disposal System
Town of Queensbury 742 Bay Road Queensbiiry NY42804_(518)-761-. 256
4: QVVNER INFORMATIONs1. {. _
Office Use
Location of installation: -• p
File Permit No. OOD?
''..!
Tax Map No. / {
F: Fee PaidC % .
wner's Named G'//1 1 Z?!f l .�Pjos
i
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Address: 6 O Y S ( o
jp 2Qp2
2. INSTALLER'S NAME PHONE NO. F QU
- E
3. RESII?ENCE,INFORMATION circle ear of ..
dwellin , indicate#bedroo ms and multiply#o hlp Ca R
U y
bedrooms with applicable gallons per bedroom to equal total daily flow}
Year of House: No'of Bedrooms x ComRixtatioii ' = Total Daily Fiow ;,
980 0l x _,150 gaUbdrm,•=. C�
1980—1991 x - ,-130.gal/b_drm
1991—present x 110 gaUbdrm
Garbage Grindei installed yes_
Spa of Whirlpool:Installed -yes
4. "PARCEL INFORMATION: . (circle_applicable information&indicate-'measurements)
Too h Soil Nature Ground Water Bedrock or ervions Material Domestic Water Su "1 .
at what depth at what depth -r unicinal3.
`-- olling oam- feet feet well `
Steep:slope clay - if well,water supply
%slope other, from any septic-system
-- -- - -- ��_ n .
absorptro is. --
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 imust be d6signedby a licensed
Professional engineer or architect(unless installed in a Planning Board approved.subdivision). Add 250`gallons to the size
of the se' c tank and-leach field for each Garbage Grinder Spa or Wh#1pooi Tub-
Septic Tank:/�CS gallon(min. size 4 000
Tile Field: each trench fT. Total SysiemLength.
Seepage Pit(s): number of size of each: }?.by ft
Size of Stone to be used: # - t depth or thickness feet
Bed System Size A� ram' z
Alternative System: ', ,.S'� N length andlor size
6. _ HOLDING TANK SYSTEM: (if required)
Number oftanks:, t 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, c�INFORMATION FOR RESPONSIBLE PERSON(Please read)
For'yourprotection.please note;that pursuant to Section 136 29 of-die,Code of the Town
of Quaensbury,',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 respectta this application and'agree to abide by these and all
requirements`of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
lgn t `:a ofresponsibte person `Date
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Plans and specifications are in full d ` 0 1
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