2001-815 TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
��� �Y
Community Development -Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number:. P20010815 Date Issued: Tuesday, November 26, 2002
This is to certify that work requested to be done as shown by Permit Number P20010815
has been completed.
Tax Map Number: 523400-296-013-0001-073-000-0000
Location: 73 MONTRAY Rd
Owner: GRAYSON PROPERTIES, L.L.C.
Applicant: GRAYSON PROPERTIES, L.L.C.
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
4
Director of Building&Code Enforcement
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: P20010815 Application Number: A20010815
Tax Map No: 523400-296-013-0001-073-000-0000
Permission is hereby granted to: LAWRENCE GRAYSON
For property located at: 73 MONTRAY 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: LAWRENCE GRAYSON Septic Alteration Residential
1004 CHESTNUT St Total Value
MECHANICVILLE,NY 12118
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY.NY
Plans &Specifications
2001-815 LOT#5 MONTRAY ROAD
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 To f Quee ury; d sday, October 31,2001
SIGNED BY 4for the Town of Queensbury.
Director of Building Code nforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queer►sb►►rp, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Location of installation: (C� f# rn y 'r Office Ilse
VTax Map No. / / � 1—.‘., Pilo Permit No.N
Owner's Name: .t' r Lj - 161 OCTt 0 200i Fee Paid
Addros r-
f U 11 / �d � '�'Cis etc
BUIL lt`1O AND CODE / - fir.
2. INSTALLER'S NAME : ll �`..�_...�..s�.�.
fj, • �T� e ( PHONE NO.2/ 8 F// y
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate II bedroom(%) and multiply II 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 = 3e a
1980— 1991 x 130 ga1/bdrm =
1991 —present x 110 gal/bdrin =
Garbage Grinder Installed yes r / no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
•"', raph a tiro .Gr ind Water Bedrock or impervious Material _Domestic Water Supply
scup at w ra c �plll at w/a %r municipalemunicipalolling loam et ./CJ fee f 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: ODD gallon (min. size 1,000 gal.)
Tile Field: each trench fl. Total System Length:
Seepage Pit(s): number of / size of each: r fl. by ID fl.
•
Size of Stone to be used: ll 3 / depth or thickness filet
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 an 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.
- )_ 00,1P
S nature of person responsible p p n Date
' CD
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name )Y CYCt
Location 'I)C \
r—
Date j1 -6 : JOIermi t # 5
SOIL TYP -Clay-
Results of Percolation Test-
(if applicab1 ) Rate-Minute/Inch
TYPE OF SYSTEM
ABSORPTION FIE D\Total Length
Length of each tre ch
Depth of trench s
Size of stone
SEEPAGE PITS: N be -
Size - ft x t� ft.
Stone size
PIPING: Size Type
Bldg. to Tank / !'f 4,cue j -
Tank to ' ---. : • mii. �-.
toFieldra '' .
Openings Sealed? ai No . Partial
LOCATION/SEPARATIO'
Foundation to Tank c5 feet
Foundation to' Absorption 1\5--.feet .
Separation of Pits _- fe-
Conforms as per Plot P an Ye- No
LOCATION OF SYSTEM ON "OPERTY:
(circle one)
Front - Rear aMMOW001Trit ' 'ght Side
Middle Front - •• e Re.r
COMMENTS:
•
b�� V- \Lam•
SYSTEM.USE APPROVED: YES NO
Arrived: I_; e/
Depart: .
1 ' At
iri ding Ins; • tor
1 ___L _.1_.__ I I __ I I I._— L___I I , - -__,-
I
a
f `'~'
k,„(-r)
1 1 [
•
1 ‘
I !
1
_,,,,,of3N ,A3,
!
r /
- /
, , ,
Op m �
-01 Ni i rip 1 n-.!
it ',I x 1 '.,.s r, ''7 ,rT'..;"..;. I 5 ya4,
I
I—LTHI
j 4 °---) I ,
Lo ,
�g -
1
ri.:il _.,.c,
Si , , , ,
, , __, - ---1----1 1 L111
0
I h. 4serlied3or oeliee I saw e�deeeof,
ail . : , ses—welis;gees—fencesiat ., 1
ri. 1_also-r-epceeit Ithat I have
sho ;"„i the stances se forth oo th6 diagram.
I
oa—I Fzji a-- piers f
-- l -I " 1 --lam )-Q' -
-,P] 100 0--1-0 ," U-IR-E { DATE
, 6
--H÷1. 1 - J1�P ;� 1
I I I I I 1 1 I I I r