2000-235 N N N
C'ertitliciate u Comlhia"Hctn
Town of Queensbury
Warren County,Now York
. May 5, 2000
.date
}
2000235
This is to certify that work requested to be done as shown by Permit No,
has been completed,
SEPTIC ALTERATION
This stnteture may be wgQd as a
11 WESTLAND AVE,
Location
Owner KC NEAL, WILL AM
TAX 9' P NO, 8 0 6«1 o b bd A Mt 4
-By,qrder Town t" .
T 0 Ry
Director of Building&Code.Enforcement
l
EITIL-D-Ili G PERMIT
Town of Queensbury, 742 Bay Road,Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 2000235
TAX MAP NO. 80. -1-25 . 34
MC NEAL, WILLIAM
Permission is hereby granted to
11 WESTLAND AVE.
Owner of property located at
SEPTIC ALTERATION
in the Town of Queensbury,to construct or place a
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.
'?'PVTAA RWD AVENUE
QUEENSBURY, NY 12804
Contractor or Builder's Name:
QUEENSBURY 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
25 April 26 2002
$ PERMT FEE PAID-THIS PERNUT BXPMES
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury be fore the expiration date.) 2 0 0 0 22 Ap
Dated at the To of Queensbury this Day of
SIGNED BY for the Town of Queensbury
Code Enforcement cer
Application for Permit-Septic Disposal System.
Town of Queensbury 742 Bayltoaii-Queensbwy, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
..........._.....................................
......................................................................
Office Use
Location of installation: ) Q;S L k
Tax Map No.
Fite Permit No—�—
Fee Paid
Owner's Name: -0 p
............... ............ -.._............... .................
Address:— r ,) e [ci v� ci L izp rci a h tP�lt.-tom
2. INSTALLER'S NAME 1 B c z PHONE.NO. �
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedrooin(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 �'-' 150 gal/bdrnn
1980- 1991 x 130 gal/bdrm =
1991 -present x 110 gal/bdrm l.T V
Garbage Grinder Installed yes / no X
4J Y��R 2 2Q00
Spa or Whirlpool Installed yes / no _ E
` OIV a,�OF -
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)BU'LD Wt`l --- -•• :=
Topography Soil Nature Ground Water Bedrock or lrn envious Material Domestic Water S upply
s at what depth at what depth mui�icip
o ing oam feet feet .. well
Steep slope clay if well;water supply
-%slope other from any septic-system
depth: absorption is ft.
other'
Percolation Test: (7:o be completed by licensed prt fessional engineer or architect)
Rate: _ ininute pet•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 Boar&approved subdivision). Add 250 gallons to the size
of the septic lank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septicnk:t Ta c� a u gallon (min. size 1,000 gal.)
Tile Field: each trench' ft. Total System Length: ft
Seepage Pit(s): number of a size of each: _ �f[. by f.
Size of Stone to`be used: # / depth or thickness . feet
Bed System Size: x-
Alternative System: length.and/orsize
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 mote that pursuant to Section 136-29 of the Cade 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. '
S' nature of responsible person Date ,
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3 .,.' , '20002 , := .MC NEAL WILLIAM `11 WES2'LAN6' AVE. c �.3
II• •-�SBPTIC ALTBflATI '. - �
APR 25 2000
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r TOWN QF QUEENSBURt lJl IUDIING I���ni{I IYiti:19
Based on our limited examination,
compliancemb our comments shall
not be construed as indicating the
plans and specifications are in full
compliance with the code.
3 :r.
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