2001-814 .411ft TOWN OF QUEENSBURY
742 Bay Road, ueensb NY 12804-5902 518 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010814 Date Issued: Wednesday, October 31, 2.001
This is to certify that work requested to be done as shown by Permit Number P20010814
has been completed.
Tax Map Number: 523400-309-013-0002-018-000-0000
Location: 471 BIG BAY Rd
Owner: LORRAINE TROY
Applicant: LORRAINE TROY
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
ciDa.,P Lit
Director of Building& Code Enforcement
TOWN OF QUEENSBURY
too 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010814 Application Number: A20010814
Tax Map No: 523400-309-013-0002-018-000-0000
Permission is hereby granted to: LORRAINE TROY
For property located at: 471 BIG BAY Rd
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: LORRAINE TROY Septic Alteration Residential
471 BIG BAY Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY.NY
Plans &Specifications
2001-814
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday, October 31,2002
(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 Quee sbury; f ednesday, October 31,2001
SIGNED BY for the Town of Queensbury.
'rector of Buildin &C -e Enforcement
Application for.Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
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Location of installation:, °1 ( /)i / C c
File Pormit No.00ffi c Use 8)
Tax Map No. / / �
Owner's Name: ,(.. N r fit • •,Pik `�' O) ' .
Address: l3 , d�, i‘rl OCT 3 0 2001
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, / „ WNI®FF QUEENSBURY gr2. INSTALLER'S NAME : t 11 > IL �1 ( �BU
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 11 bedroom(s) and multiply Il 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 gs'l x 150 gal/bdrm = 3 00
1980— 1991 . x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes / no </
Spa or Whirlpool Installed yes / no x
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
"° ►raphy 1.' aturo Ground Water Bedrock or Impervious Material-- ---_. titer Su; jy
'%7at sand -at what depth at wha ptlr r runiciperl
ing oa (eet eet well
Sleep slope clay r well; water supply
_%slope other from any septic-system
• depth: absorption is fl.
other
Percolation Test: (To be Completed by licensed professional engineer or architect)
••
Rate: minute per inch
5, PROPOSED SYSTEM: For New Constniction: 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 lieRfor each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: /00o gallon (min. size 1,000 gal)
Tile Field: each trench o fl. Total System Length it
,.,,-,, ,
Seepage Pit(s): number of size of each: fl. by fit.
/A/
Size of Stone to be used: it / depth 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 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 au applicant, shall be void.
I have road 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.
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