2001-763 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: P20010763 Date Issued: Wednesday, December 19, 2001
This is to certify that work requested to be done as shown by Permit Number P20010763
has been completed.
Tax Map Number: 523400-289-007-0002-023-000-0000
Location: 23 YORKSHIRE Dr
Owner: SHERMAN &EVE PARKER
Applicant: SHERMAN & EVE PARKER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(-3J/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: P20010763 Application Number: A20010763
Tax Map No: 523400-289-007-0002-023-000-0000
Permission is hereby granted to: SHERMAN&EVE PARKER
For property located at: 23 YORKSHIRE 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: SHERMAN &EVE PARKER Septic Alteration Residential
23 YORKSHIRE Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
SIGNORELLI & SON
589 WEST MOUNTAIN ROAD
OUEENSBURY,NY
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Plans &Specifications
2001-763
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday, October 12,2002
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of sbury befo e the expiration date.)
Dated at the Tow o n n1. .-- 5 ctober 12,2001
SIGNED BY J 4 for the Town of Queensbury.
Director of Building&Code Enforcement
H
Application for SEPTIC DISPOSAL PERMIT CD
STAMP RECEIVED Z
Location of property for installation: ,2 3 ` 45//d e ,0/�l lieO
Owner's Name P1litli key PERMIT IIUMBER 10
3 Yei,oks4ede hReve. c6Vtri
Owner's Mailing Address: prl
/ �//, FEE PAID `�5, Z
Installer's Name: 0�� J' 47'4e (`i Phone #: 90 l�� /� _ C4
tZi
v RFC
�` ` Hlt D
Number of bedrooms (if residential): V OCT 11 200i
Total daily flow (residential -compute @ 150 gal. per bedroom):
TOWN OF QUEENSBURY
BUILDING AND GODS
Topography: Flat I I Rolling I-1 Steep Slope —%df`'S ripe, a-.-- ---__
Soil Nature: Sand I Loam n Clay Other /Depth:
Ground Water: at what depth? feet
Bedrock or Impervious Material: at what depth? feet
Percolation Test: Not Required I-1 Required/Rate min. per inch
Domestic Water Supply: E Municipal I' Well [-1 Other
If domestic water supply is a WELL: water supply from any septic absorption is feet /
C%Se r uJet/ f s //a
PROPOSED SYSTEM:
Septic tank: gal. (minimum size: 1,000 gal.)
Tile Field: each trench feet. / total system length feet. / fAei'64
Seepage Pit(s): number of / size each: ft. x ft. SC) /
Size of stone to be used: # / depth or thickness feet. 6'-„1 6KJ /N/ OA14"1
HOLDING TANK SYSTEM: (if required) e eJti'P,g_ ,, ,,// f,1jS/.4_/( 2
Number of tanks: Size of each: gal. ,JLD(41 i-6141 �`1e/S
Alarm system and associated electrical work to be inspected by a certified agency.
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 o f the Town of Queensbury Sewage Disposal Ordinance.
Signature o fresponsible person: Z� Date: /Q—l/O(
C_Sd — /CRU
TOWN OF QUEENSBURY uti9n
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date/ Permit #0/7- --76
SOIL TYPE: Sand-Loam-Clay-
Results of Percola ion Test-
(if applicable) Rate-M nute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone /
SEEPAGE PITS: Number
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Ye No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROP RTY:
(circle one)
Front - Rear - Left Side - 'ight Side
Middle Front - Middle Rear
COMMENTS:
\V€Pt b��.
SYSTEM USE AIsPRO`VE J ESQ NO �
Arrived: - I
Depart
/Bu' ing Inspec r
TOWN OF QUEENSBURY rl V
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name RR(L61
Location --CS YoR,I, Kkte(-- OR
Date 4A, b ) Permit # e) ( — 767)
SOIL TYPE: Sand Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: 9
ABSORPTION FIELD: Total LeAgXh j Z.
Length of each trench ),
Depth of trenches
Size of stone L _C S.,
SEEPAGE PITS: umber-\
Size - t. x 1 ft.
Stone size 1
PIPING: 1 Size Type
Bldg. to Tank
Tank to Dist. B x f
Dist. Box to Fi l d/P ,.. ' --47v.i77-6
Openings Sealed /Yes No . Partial
LOCATION/SEPARA IO •
Foundation to T.6 feet
Founti-ata-on—to A.sorpti on . _ feet
Separation of Pits __ feet
Conforms as per Plot Plan No
L ION OF SYS EM ON PROPERT .
,ri' c e one)
Fro - Rear -11 Side - Right Side
iddle Front - . . .le Rear
COMMENTS: f , • _ O Fi & -� 0I.<
O
� 1�
•
RcfLiCL A-LL I D 1 C C--r5 3IP
5 0'M A-0gbVA-L
SYSTEM.USE APPROVED: YES 110
Arrived:
Departed: d� 3LA /
Building Inspector
�J �.•rnf
ry►.,.� •
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name -ipakkoz_.:
Location L_.
Date Ic0 15/0 'emit #1:Xo1" lk23
SOIL TYPE: Sane oam,-Clay-
Results of Per olatioh Test-
(if applicable'' Rate- �Nnute/Inch
TYPE OF SYSTEM: grkiLTt+4A,-
ABSORPTION FIELD: Total\ Lel h 5 -'
l
Length of each t enchl 1
Depth of trencts
Size of stone CAL
SEEPAGE PITS: Numb
Size - ft. • ft.
Stone size _�
PIPING: Siz Type
Bldg. to Tank
Tank to Dist. Box 7527576
Dist. Box to Field/Pi I`
Openings Sealed? 0 No Partial
LOCATION/SEPARATIONS.
Foundation to Tank _feet
Foundation to Absorption . feet . .
Separation of Pits ,feet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPER
i c one)
ro - Rear - i .ide - Right Side
Middle Front - is .le Rear
COMMENTS: RAC.v-L. .
��. 40 54: 0 , l'u �L �
2 L,4-7kc- Te> 1/✓ _�<< -o
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector
eat i I-.-� .
IF
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d - OCT 1 1 2001
k �$�` TOWN®F C�IUEENSB
� ‘01 t
"I have seen or observed, or believe I saw evidence of,
It all objects such as houses, wells, trees, fences, etc.,
shown on this document. ! also represent that I have
11d personally measured the distances set forth on the diagram "
yi_., SIGNATURE DATE
►pide41'�' pip'-fed . 1M'K-
site
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• TOWN OF QUEE -4:Sr-URy
BUILDING & ` .y 4 7 r37.
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REVIEWED BY
DATE , ...._ a .._--
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