2001-883 014. TOWN OF QUEENSBURY
742 Ba Road ueensb NY 12804-5902 518 761-8201
u I Y ,Q �Y, ( )
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010883 Date Issued: Monday, December 03, 2001
This is to certify that work requested to be done as shown by Permit Number P20010883
has been completed.
Tax Map Number: 523400-301-017-0002-016-000-0000
Location: 69 JOHN St
Owner: LAWRENCE PARKER
Applicant: LAWRENCE PARKER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN O QUEENS:URY
Director of Building& Code Enforcement
-ter--. TOWN OF QUEENSBURY
M
fF 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010883 Application Number: A20010883
Tax Map No: 523400-301-017-0002-016-000-0000
Permission is hereby granted to: LAWRENCE PARKER
For property located at: 69 JOHN St
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 PARKER Septic Alteration Residential
69 JOHN St Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2001-883
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, December 03,2002
(If a longer period is requited,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at e To of e b , ; �►�'on s.,y,December 03,2001
R". ,* for the Town ofQueensbury.
SIGNED BY '
Director of Building&Code Enforcement
I '
Application for Permit—Septic Disposal System
Town of QueensInny 742 Bay Road Queensbury,NY 12804 (518) 761-8256 .
1. OWNER INFORMATION:
t`� Office Use
Location of installation: / �4 t 4 /f i 2
File Permit No. (-y3 J
Tax Map No. / ' /
f Fee Paid aS; ``'�
Owner's Name: Lk f,� 60--rc.-e g. i , e. )
Address:
2. INSTALLER'S NAME : a
ton is ,Ce a v c, Sok.J-2-1' PHONE NO. 7 T j C4 b
. 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 =
(1980— 199 —• x 0 aJlbdr •
—
1991 —present x 110gal/bdrm = P�'P�`�,d ®
Garbage Grinder Installed yes ,op NOV 3 0 2001
Spa or Whirlpool Installed yes / C
TOWN OF QUEENSBURY
4. PARCEL INFORMATION: (circle applicable information &indicate measurements) BUILDING AND CODE•
Topography Soil Nature- Ground Water Bedrock or impervious Material Domestic Water Supply
61Zr[ san at what depth at what depth manitc
Rolling oam feet feet .
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:(6-v—r/ gallon (min. size 1,000 gal.)
Tile Field: each trench (0 ft. Total System Length: .2c7,—c) 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: `Irk(4-4S length and/or size 6--z)
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 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.
VL'uLi2J //j/h/'77- �7
Siglhattu3e o responsible person Date
x TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name c>6„,, ,,cio,,,VOce,7
Location (e. ,\A
Date - - �''ermit #p f' gj
SOIL TY : San ol a -Clay-
Results of Percolation Te,t-
(if applicable) Rat:-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tital Length .fin
Length of each trenc - _55 a
Depth of trenches A 1
Size of stone i
SEEPAGE PITS: Numoer-
Size - ft. x ft.
Stone size
PIPING: ,ize Type
Bldg. to Tank ma _ ,�-1 �
Tank to Dist. Box 's Qkt—
Dist. Box to Field/Pit a V1(..,•E ,�
Openings Sealed? s Na Partial
LOCATION/SEPARATIO S:: -
Foundation to Tank IQ feet
Foundation to Absorption LD feet
Separation of Pits eet
Conforms as per Plot Plan . Yes 2No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left--S—fde- ight Side
Middle Front fiddle Rear
COMMENTS:
SYSTEM USE APPROVED: 00011111110NO
Arrived: ,i a L/
Departed: r �r
1.�. At)
• din, Inspe or
„ . '/+
"I •
,.
. .
__, ,,,,,,
. . have seen of i - 7
all objects en o observed,
{= 11�� F' •.j
or believe I '”-{��� � ,
shown c this h as houses, wells, trees,sf fences,evidence of,
Aers Ily hi ` P-nt. I also represent
, etc., NOV 3 0 2001
measured the distances
et fQrdthat 1 have
�h o, diagram."
p►ny� TOW1i�111OF��^^Qlpp1EENSBURY
the Cra��l.I/ BUI�,.7J�lyl9 Motl®Vo®�
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