2000-277 ..1v ��,.y�ii'4. rI o•� e,✓��S"Q"V ;F4.t'�r✓It� y^rwYl,.i'wyy, j6'�4 , s - V k JMr- w•1 .�
e-6 A
rt cate of, Com" lance
Town ofueensbury
Warren County,New York
Date June 1
. `own b Permit No. 20��277
This is to certify that worn requested to be doge as shown y e
has been completed,
This stricture may be used as a .. SEPTIC ALTERATION
J
Location 228 CORINTH RD
Owner M1
TAX MAP NO, 128.-8M 7 By 4•rder Town Board
OF Q ' END
Director of Building&Code•.Fnforcexnent
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 2000277
TAX MAP NO. 128 . -8-7
WOOD, RALPH & KATHLEEN
Permission is hereby granted to
Owner of property located at 228 CORINTH RD.
in the Town of Queensbury,to construct or 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:
228 CORINTH ROAD
QUEENSBURY, NY 12804
Contractor or Builder's Name:
SMITH, FRED
Contractor or Builder's Address:
23 VERMONT AVENUE
QUEENSBURY, NY 12804
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
25 May 5 2002
$ PERMIT FEE PAID—THIS PELT EXPIRES
{IT-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 of Queensbury this 5 Day of May 2000
SIGNED BY ' for the Town.of Queensbury
Core Enforcement Officer
�iF�'GNt�I'�... LUxcl r}�•-�-► a�c,� �ho�:.!_sytzl�
Application for Permit—Septic Disposal System
Town of.Queensbury 742 Bay Road Queen'sbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
.................._....................._...................:..................:.......
A�2 Office Use
Location of installation: r
File Permit No �_ 17 Tax Map No. ,
I...Fee Paid
Owner's Name:
/ rV t/C/✓
....._.........................._-.........................._.........................,..................... -'
Address: 5�/
2. INSTALLER'S NAME G S I*J- PHONE NO.
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 = 46 0
19 — 1 x 130 gal/bdrm = ��
1991 91 -present x 11'0 gal/bdrm = '
Garbage Grinder Installed yes_ / no y 0 4 2040
Spa or Whirlpool Installed yes; / no QC_. M1
OWN OF QUEENSBURY
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
BUILDING AND GORE
0 o rat)hv Soil Nature . Ground Water Bedrock or IMpervious )pinestic Water Su 1
Qz� san at what depth at what depth unici
Rolling loam feet - •feet well
Steep slope clay ifivell;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: /d&O gallon(min. size 1,000 gal.).,
Tile Field: each..trench ft. Total System Length: ft.
Seepage Pit(s): number of size ofeach: ft. by ft. -
Size of Stone to be used: # / depth or"thickness feet
Bed System Size: x
Alternative System: length andlor size
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-die Code of the Town
of queens, 4ry, 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.
1 le,
Signature of responsible person 6ate
4J4J 0 (�
0 0) 4) b
4— 4—
Gh� v �rUr. 1IMr ;
a H r 0-
N I
0,
it
�CCu
as M ,� . O
WU E X FI C U) �aWicl � d �It r. � Q) SW -C u , 4)9 CL V) spa
1 W ro c� + 0I. +j � 0
ii roV) v s � 0)W cncr U )w � � M U} U) C C C f $ dW OwVi 4- 0 N a \ 000
�,
r 6*{ �
r-or- U)z LL a
W 0 r U) 0.�M 0 04-W 4J 0,M C) -P4.) 4)
Ist'sA. 4 r- ro 'a +J Z as i . 'r b.0 s d Up,�»W W
W v u W 0 W C9 Cyt cU 4 Q) H 0).'i � + C C m-4.+ � Ir IC
U +� U14- U) CaNWN0P, `dC04)Uj � aCU.r0 `�
(0 -0 L�
.0 03 0 it�""MQJ0) Wr�. 4JHrro,r• 0.00dN00U, S .r-o y �,
A 0-I Lt.. U.0 U��LL X U � � �
V)
i
' � ti,i•Lq��f•fQ}y�i•(�t^i rty �"A.� O'inu�,.A 9r�A
l�
J7 r .
60y'.
EVE
gay o z000
UEENSBURY
'OWN OF t�
BUILDING AND CODE
:�' '200m217,, 1.284-8=.7
bsery ,o ekue.l sawLduidence of,
all objects such as houses,wells,trees,fences,etc.,
shown on,this document,I also represent that I have
personally measured the distances set forth on the diagram,"
SIGNATURE DATE