2000-207 Certi ica e o omp iance f f C I
Town of Queensbury
Wren County,New York
April 18 , 2000
Date
2000207
This is to certify that work requested to be done as shown by Penult No,
has been completed, I
SEPTIC- ALTERATION. (,BLDG -E6 )
This stricture may be used as a
BLDG E6 MANOR DR.
Location
QUEENSBURY MANOR
Owner
TAX MAP NO, 78 . -1-8 . 2
By Order Town Board
OF EN�11 N, Y
(IV
Director of Building &Code'.enforcement
BUILDING PERMIT
Town of Queensbury,742 Bay Road, Queensbury;NY 12804
County of Warren (518) 761-8256
VALUE _ $ 0 Building Permit No. 2000207
TAX MAP NO. .78 . -1-8 ..2
Permission is hereby granted to BRYAN, J. BUCKLEY, JR.
Owner of property located at BLDG E6 MANOR DR.
in the Town of Queensbury,to construct or place a 5 F,p T T r A T,T ERATT ON
at the above location in accordance to 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.
Owner's Address:
70 MANOR DR.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
UEENSBURY SEWER
Contractor or Builder's Address:
JAY SWEET
0 . .
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION. AS PER. PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
$ 2 5 PERMIT PEE PAID—THIS PERMIT-EXPIRES- April 17 2 0 0 2,
(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 Queensbury this �17 Day of April 2000
SIGNET)BY for the Town of Queensbury
Code Enforcement Officer
Application for Permit—Septic Disposal System.
7'oYYT1 of QueelTslTUTy 74213riyRoad Queensbury,NJ' 12804 (518) 761,8256
I. OWNER INFORMATION:
/ _................................ _........................................................................_...
Location of installation:
rl � y� office Use
Tax Map No.
File Permit
/ / �
Owner's Name: ((. L�.
Fee Paid
Address:)M.a- h i� r —VV .' `j5��c, tom, ee AX-?Cc ^�
2. INSTALLER'S NAMES (a C (L,? g_{ , 1��, PHONE NO y`
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/bdrnr =
1980--1991 Clli< _: x 130 gal/bdrm =
1991 —present x 110 gal/bdrm -=
Garbage Grinder Installed y s_ / no
Spa or Whirlpool Installed yes / no �_ ✓ APR 17 2®�
TOVI'f.l OF Q'UEE JE 3URY
BUILDING l�f�®Ck=,tDE
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
To o rra h Soil Nature Ground Water Bedrock or]m ervious Material Domestic Water Supply
Fla .' -sand at what depth at what depth- zcniaipa
Rolling earn feeC feet
Steep slope clay ifwell; water supply
slope other from any septic-system
depth: absorption is fi.
other. _
Percolation Test: (To be completed by'liccnsed 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.
)c:07
Septic Tank: gallon(min, size 1,000 gal.)
Tile Field: each trench 2) jt. Total System Length:
Seepage Pit(s): number of size ofeach: ft. by ft.
Size of Stone to be:used: it . ` / depth or thickness / /i et
Bed Systern Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: -(if required)
Number of tanks: t 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 die-Town.
of Queensbury; any permit or approval granted which is based upon or is granted in
reliance upon any material mismpresezitation 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.
Si nat re f responsible'person Date
4? 'N 4J 0 Q)
�} Oro. 0 (J Q)z `o
N Q Q) 4J
� � V
z w 4-
0-4
oa 0.
I vC c ro� a) (D v
V) �!. 9 w 0 0 r CL C'
zz o� N CE ro ' , (V 'r 4 , ►r p,
C® N ro rU N E ro 0 to r 4- *o C�Gm J r Z S. N 0 -P Mry C 04JaW Q)U. U 'r
N U J .� CA r 1— d a,
C s. olwz U U. a1 ' - 0 >. ' t 4 rt
rd v r w H U Co r~4 0' C �iw. a� 4
Gh t4t1 CL .0�' w00CN9 C4J004P -Po, S. �
C Q (d V) tU 'o!�' ro 0 41 a)w w w 4) ro C
U�*� 4- () � "N M } �--� 'r- vy V) C C C Ri C! C N 0 w
Q • ►, 0 'r 0 6 4» to a N c x ''"'N o o o . o �� (A
r 04 0 4. 'r 0 0 V) 'r 'r 'r, N ' V1 #
0 to C.I. o4.W r� 4J 000 0)� u +) � 0 tiQ
4' OLO Q .0 0 0 t 4J C H rd (d rd H Z
r rd •W .0 Q 4)Z ° 'r- *0 `o �0 jim� U 4 W >
w 4) S 0 W 0)4� a)Q. 0 C�4 M-Y 4-) C C C''(d 4-4 S- C -0 yo'
V) E U 4J Vt4- QV7CC. NwN0CLIOCrn0UC0C.CU ,r0 .0 V a
rtl 0 (0 0 Q) 'r `d■M a) 0'r-W 'r P to e- (0 'r a Q 0 0 1 .0 0 G L -r Q S» 0
. I
J
t �
( 3
APp 17 2000
BUILD', ,ti -URY
° � r� �'� �� ` "I have s `"'"'~�,--....
en or o6serued,ar believe I sa
ILD� all objects such as houses
°n 'tiw t .� � shown on this ,wells,trees f�evidence off,
is document,I also re ►fences,etc,,
j REVIEWED Y p. lly measuted the disc present tha I have
DATE es set forth n the diagram,
SIG
`z0 �zm .78 1' 8 .,2, , µ1t° DATE
DUCALEl ,r-JR
BI;DG E6-.MANbi'DR�:�'
SEPTIC b EATION