2001-753 0106. TOWN OF QUEENSBURY
742 BayRoad,Queensbury, 12804-5902 (518) 761-8201
Form" Q wY,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010753 Date Issued: Monday, October 15, 2001
This is to certify that work requested to be done as shown by Permit Number P20010753
has been completed.
Tax Map Number: 523400-301-012-0003-029-000-0000
Location: 32 PROSPECT Dr
Owner: DEBORAH W TITUS
Applicant: DEBORAH W TITUS
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
C3J11
Director of Building& code orcement
T ` TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010753 Application Number: A20010753
Tax Map No: 523400-301-012-0003-029-000-0000
Permission is hereby granted to: DEBORAH W TITUS
For property located at: 32 PROSPECT 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: DEBORAH W TITUS Septic Alteration Residential
32 PROSPECT Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
SIGNORELLI & SON
589 WEST MOUNTAIN ROAD
OUEENSBURY,NY
Plans &Specifications
2001-753
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFCATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday, October 09,2002
(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 of Que sbury; Tuesday, October 09,2001
SIGNED BY for the Town of Queensbury.
Director of Buil.r T g& k de Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
1
S'0' . ' AA Aci ti4t/� Office UseLocation of installation: _ i geDJ_
File Permit
fifi N
Tax Map No. / /
Owner's Name: //!�� Fee Paid
• S, ate
Address: 3 a Pao 5/ 'c / 6e l ve_
2. INSTALLER'S NAME : d.i/ -/ d/a//e t f PHONE NO. 7902���
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 d-'
1980- 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installedr� C I®"� _�"
g yes- ./ -s
Spa or Whirlpool Installed " yes- Id9
OCT 0 2 2001
4. PARCEL INFORMATION: (circle applicable information&indicate measureme N OF QUEEBU gs,U:_
IP�lG ANQ OO®DE_
T y Soil Na ure Ground Water Bedrock or Impervious Materi D ater Supply
?at an' at what depth at what depth ( municipa?
oiling, oam feet feet. well
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 gP3 fT. Total System Length: /30? ft:
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
Alternative System: 1/.:G(:44-(d/ length and/or size
f
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.
51 v--mo d
Signature of esponsible person Date
TOWN OF QUEENSBURY 4.AA
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name TUS
Location 32- PRP -CT
Date ro f L JO ► Permit # I - 76-37
SOIL TYPE: Sand Loam-Clay-
Results of Perco ati'pn Test-
(if applicable) R.-te-\ inute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: ' ot.l Length
Length of each tre ch
Depth of trenches
Size of stone IF
SEEPAGE PITS: Numbr-
Size - ft ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pi
Openings Sealed? Y s No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorptio feet , .
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
//9"/W/ —PAIR
•
;, ',)SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
111116‘ (
Building Inspec or
-'7. 9A4)/
lJ�
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location , 3a �C Dr
Date 0 —1 A4 Permit O[ 753
SOIL TYPE: Sand ' oam-Clay-
Results of Percol ..tion Test-
(if applicable) `at -Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELL: To al Len th /7i
Length of each renc i 3
Depth of trench
Size of stone A)F c.i;It.A-cOv
SEEPAGE PITS: umbe -
Size - 't. x ft.
Stone size
PIPING: — , „Size Type
Bldg. to Tank /5 1i N0G
Tank to Dist. Boy 4-" 54-0
Dist. Box to Fiel',/Pit :- tx
Openings Sealed? Yes No .Partial
LOCATION/SEPARATIO` S:
Foundation to Tank /V4 feet
Foundation to Absor. ti on . U .feet
Separation of Pits r feet
Conforms as per Plot Plan - No
LOCATION OF SYSTEM 0 \ PROPERT .
(circle' ')
r)/
Front - Rea - Left Side - Right Side
Middle F tit - Middle \ear
COMMENTS:
4k-A-'- T- :
CN 0 /9-5
C ACt.--
, Acx6el<
SYSTEM.USE APPROVED: YES NO
Arrived:
-- -t:/47.
`Departed: ,
,,le(--------
'Building Inspector
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TOWN C}_ , . Y4., NscURY
1 BUILD I ' e far- v, • EPT ;
, REVi
DATE UVEG
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- -c;alo 1 . 753 I • . ,
* EcEivE.0._ . 1 .
i 1
OCT 0 2 2001
TOWN®F OUEENSBU_ Y
ili
331 332 ' A 3 °
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71-j5 �7'0- "I have seen or observed, or believe I saw evidence of,AO all objects such as houses, wells,trees, fences, etc.,
Pj) shown on this document. I also represent that I have , I
P g personallysured the •distance •forth on the diagram.'/.
SIG TURF • DATE