2000-230 AMU1 c
Certificate of Com1^11ance
Town of Queensbury
Warren County,New York
April 24 , 2000
.date
200@2S0
This is to certify that work,requested to be done as shown by Permit No,
has been completed.
SEPTIC ALTERATION
This structure may be used as a
23 EAST DR.
Location
Owner RARRY, RICHARD n JR a
TAX KP NO. 93.-3-3. 1
By Order Town hoard
r ,. OWN OF QUEEN BURY
r
f1
Director of Bu ding& Codp Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
VALUE $ 0 Building Permit No. 2000230
TAX MAP NO. 93 . -3-3 . 1
Permission is hereby granted to BARRY, RICHARD, JR.
Owner of property located at 23 EAST DR.
in the Town of Queensbury,to constructor place a SEPTIC ALTERATION
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:
23 EAST DR.
. QUEENSBURY, NY 12804
Contractor or Builder's Name:
MCGUIRE, - RICK
Contractor or Builder's Address:
Electrical Inspection Agency:
Type of Construction:
SEPTIC-,
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATION
Proposed Use:
SEPTIC ALTERATION
25 Apri 1 25 2,002
$ PERMIT FEE PAID-THIS PERMIT EXPIRES
(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 T%off Queensbury this 25 L_Day of April 2000
SIGNED BY for the Tovift of Queensbury
Code Enforcement Officer
Application for Permit—Septic Disposal System
TOW/1 of Queensbiny 742 Bay Road Queensbury, NJ' 12804 (518) 761-8256
1. OWNER INFORMATION:
............................................... ...................................................................
Location of installation: office Use
Tax Map No. File Permit No. eu
Fee Paid
Owjier'sName:._ �,CkA.Aaio
Address: J'7 3 j 10,e, 9
2. INSTALLER'S NAME :---. R, Q_K . M 6=<.-U 1 y2G PHONE NO.
3. RESIDENCE INFORMATION; (circle year of dwelling, indicate ft bedroom(,)and multiply ff of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Ye of House: No. of Bedrooms x Computation = Total Dail.e
E: ED
Z9 8 0 or H,10du. x 150 gal/bdrin = t a
1980- 1991 x 130 gal/bdrin = APR 2 5 2000
1991 -present x 110gal/bdrin =
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
r-119PAMP—hy— ;9"atul,Q (arpt id Wa Bcd!jocicpr Impe.rvious Material LQjLUn.-X1_q_ .11 1L5_t11n1j_y
V _�?V kdii If
)ZF0,7ling un ,feet f
�1_1
i7 t at WIC e 'th at what MIMIC
Steep slope clay if well; water supply
_Y6 slope other from any septic-system
depth: absorption is_j?.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: Minute her inch
5. PROPOSED SYSTEM: For NeW Construction: All individual sewage disposal systems must be dcsignedbya licensed
professional engineer orarcliftect(unless installed in a Planning 13oardapprovcd subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: IdJ'?:) gallon(min. size ],000 gal.)
Tile Field: each trench 51-- ft. Total System Length: ZA;
Seepage Pit(s): number of size ofeach: ft. by—fi.
Size of Stone to be used: ft / depth or thickness J&el
Bed System Size: X
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required),
Number oftanks: Size of each:_gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspe6tion 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; apy.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 oil behalf ofan applicant, sliall 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.
C) C)
Signature of responsible person Date
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.2-3 'EAST;,DR;. RECENED .
EPTIO, LTUATION . .
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APR 2 4 NOO
TOWN11 OF OU1:5 URY
aUILDiI�I, ICU DODO
o TURN OF �
U
!D REVIEWED BY .
- ------------- V DATE 0
TOWN Or'QUEENBBURY BUIOING DEPARTMENT "I have seen or
Based on our limited examination, observed,or'believe 1 saw evidence of
compliancetith our comments shall all objects such as houses,wells,trees,fences etc, 1
not be construed as indicating the shown on this document,'I also represent that plans and speci6rations are in full personally measured the distances set, at 1 have
compliance nth the code. et forth on the diagradt,
. ._._ ...._.__.._� SIGNATURE—
DATE