2001-882 41ft TOWN OF QUEENSBURY
Road,Queensbury,NY 12804-5902 (518) 761-8201
�� Bay
742
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010882 Date Issued: Tuesday, December 04, 2001
This is to certify that work requested to be done as shown by Permit Number P20010882
has been completed.
Tax Map Number: 523400-296-017-0001-033-000-0000
Location: 13 GREENWAY Dr
Owner: ALBERT &LETA HEDGER
Applicant: ALBERT &LETA HEDGER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(---- aNP 4
Director of Building& Code Enforcement
1
•
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
, •
Office Use
Location of installation: r'� e �✓(.¢ ) �P,
Filo Permit No. o f?`C.� Yc
Tax Map No. �5,o�
/ • Fee Paid
Owner's Name: o) t/P
•
Address: S it t e
•
2. INSTALLER'S NAME : l p�� A'4 E PHONE NO.
• 3. RESIDENCE INFORMATION: (circle year of dwelllin ? iicate#bedroom(s)and multiply
g, ultiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x 'Computation = Total Daily Flow • •
9 0 or older x 150 gal/bdrm /-( ) FCF VED
1980— 1991 x 130 gal/bdrm = NOV 3 2001
1991 —present x 110 gal/bdrm =
TOWN OF 9UEENsBURY
Garbage Grinder Installed yes / rro • BUILDING AND CODE
•
Spa or Whirlpool Installed yes_ /
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
r 41270 at what depth at what depth
oiling loam feet feet well
Steep slope clay if well;water supply
%slope other from any septic-system
• depth: absorption is ii.
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)
• e-Field: each trench ft. Total System Length:
Seepage Pit(s): number of size of each: f[. by ft.
Size of Stone to be used: it / depth or thickness feet
Bed System Size: •
x
t
Alternative System:,,C(C.c; 7(,) 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 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.
Sig at re of r ponsible person Date
TOWN OF QUEENSBURY
` 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010882 Application Number: A20010882
Tax Map No: 523400-296-017-0001-033-000-0000
Permission is hereby granted to: ALBERT &LETA HEDGER
For property located at: 13 GREENWAY 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: ALBERT&LETA HEDGER Septic Alteration Residential
13 GREENWAY Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2001-882
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Tuesday,December 03,2002
(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 a own u ns ij . •/ 14 day,December 03,2001
04,
SIGNED BY / \ for the Town of Queensbury.
Director of Building&Code Enforcement
? 0 ' )
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY I2804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 46-DCoe.- -)--
Location 62.LGJk +O(2>
Date IZ,y /04_, Permit # CD(' E?2—
SOIL TYPE: /Sand- oam-Clay-
Results of Percolation Test-
(if applicable) Rat:-Mi ute/Inch
TYPE OF SYSTEM: I
ABSORPTION FIELD: Total L-n the 23�
Length of each trenc I -,
Depth of trenche
Size of stone foF1 ‘o
SEEPAGE PITS: N .mber11111
Size - ft. x ft.
Stone size ., �
PIPING: ' Size Type ,--
Bldg. to Tank ct 0.2..:35
Tank to Dist. Box f 5�
Dist. Box to Field/P. u
Openings Sealed? Yes No Partial
LOCATION/SEPAPATIO ••
Foundation to Tank AO feet
Foundation to Absorption --5 -feet
Separation of Pits _—'•"1 eet
Conforms as per Plot Pla a No
LOCATION! OF SYSTEM ON PROPERTY:
(circle ,
Front - Rear - Left Side - Right Side
Middle F - Middle Reear
COMMENTS:
•
SYSTEM USE APPROVED: Ai
NO
111
Arrived:
Departed: / j ::)
4/126>
Building Inspector
TOWN OF QUEENSBURY
BUILDING :A► ► IDT.
REVIEWED BY i i L
r
DATE ' MA , R.
2000®w_ miming
Aeinf3SN 110 O NM®J.
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"I have seen or observed, or believe I saw evidence of,
ail objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have
1 personally measured th- distances set forth on the diagram."
va
SIGNATURE �� � �
DATE
1