2000-343 a � s
fypt",C icate vi If f
Com"pliance
'town of Queensbury
Waxen County,New York
Nay 19 r 2000
.date
2000343
This is to certi y that work requested to be done as shown by Permit No,
has been corn feted.
SEPTIC ALTERATION
This stntcture may be used as a
27 WI TEEREEM RD,
Location
Owner DDCHARME, ARTHUR & MARY
TAX 4A0 K3 AA M 1 1 9 0 w V-'V
By Order`Dawn ward.
T QU N
Director of Building& Code`Enforcement
I
I '
t I i
xY1ytMNMaMAMMw�!^N.,,,,,,,,� __ MMYWYM'rCYY
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 2000343
TAX MAP NO. 119 . -5-8
Permission is hereby granted to DUCHARME, ARTHUR & MARY
Owner of property located at 27 WINTERGREEN 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 Budding Codes and the Queensbury Zoning Ordinance.
Owner's Address:
27 WINTERGREEN RD.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
SANITARY SEWER
Contractor or Builder's Address:
DAN DRELLOS PO .BOX 224
GLENS FALLS NY 12801
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER ,PLOT PLAN ,SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
25 May 17 2002.
$ 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.)
ury this 17 sb '
Dated at the To f Queensbury of May 2000
SIGNED BY for the Town of Queensbury
f
To
En orcemelit Officer
F Allpiicatiou foi• If'erulit---septic Disposal Systoill
7b1vu u/•Queetttblily 7,12 Buy Road rtcwir.cb,Jt 1; N1' 1280.1 (.SItY) 761 82.9G
I. OWNER INFORMATION:
........................................................................
2-1 G� fv err• vs
Locatiolt ol'iustallation: ! 7`Za,.yR-2e�/ jt�./�}
_ r 1
Tax Mal)No. / / I7ilo ilortnit No. Zl - as
t7
Owner's Name:1f7�It-!n � A- PI I Ireo Paid o� �
Addross: _ I C
2. INSTALLER'S NAME : MAY 1 7 2000
TOWN OF OUF-FNSB0RV_-
T" R- a�L✓¢•v ¢.t,�. PriONI'sNO: -71v1 .`-7,� J' �"
3. RESIDCNU INCOItMA'rION: (circitiyear or(lweilinl;, indicate 11 be p t Nttl�ti ttlta
Gecliovns witty applicable gfiJlu u per bethwom to equal to/al daily. loll,)
Yoar of 1 fotlso' No of Bedrooms x Colliruttif ion lLIotiv
1980 or older 3 _ x 150 ballbtlum = ySp
1980— 1991 x 130 gal/bdrnl =
1991 —preselit x 110 gal/bdl
Garbage Grinder Installed yes / Ile
Spa or Whirlpool Installed yes / Ire
4. PARCL''L INFORMATION: (eircio npplieable irtforrrrsttiott 14t inclicnte utoasutwttenis)
e t) J —i So' n uro Gfitr y11u4t1ttcJ!t Wc%ptNeltI%7ta /3Jk
7l _I
fit 1nhtt depthI?om-i cil W�tc�_Stq?Illy
We
Steep slope Ckly iJ'1ve1/; luvter sllppty
°o slope other p f-0111 fitly septic-systent
depth: absoiptivn is Ji.
Il0rcbl8tiQI1 Test: rlt,be tbmpleted by licensed pl-f yi>ssivnal engineer ut•tlt•chitect) Other
hale: 1111Jn,te Per inch
5. PROPOSED SYSTEM: Igor New Coustritction: All individual selvage disposal systems Inust be designed by a licensed
prol'cssiolml engineer or archilcct(unless iost.illed 111.1 111am1ing Hoard al>Illlrvcd subdivision). Add 250 gallons lu IJte siic
of the septic tank and leach field f'er tacit Q11b.1ge Grinder, Spa or Wiliillrool Tub.
Septic'Tank: ��� gollutl(min. Size 1,oua gcdl
'Pilo Field: each french V O Jl. Tvtal System Lettg(ji:� �� D Jl.
Seepage Pit(s): member af��
Sizo of Stotto to bo itsetl: ll��—�^—- / depth
Ded System Size: x
Alternative System: . length andlot•size
G. HOLDING TANK SYSTEM: (if required)
Nunlbor-of Onks: / Sizo of each: gallons /TO.1'AlL Capacity: gallons
Note: Alarm Systelil and associated electrical work must bo inspected by a'town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON (please read)
For your prot.oction, please mote that pursanat to Section 13G-29 ofdto Code 0171l10'1'own
orQucansbtrry, nny permit of,approval 811-artted which is based upon or is granted in
rotinnco twott ntly inatorial In ISrCi)i"CSG•IIIaCIOtt or C;1uro Io nrtico:1 nlatwi:l! 1 1c1.or
circttntstaitco known by or on beitalfvran applicant, shall be void.
1 ilnvo rand tale rotsutntions with roxitect.to this lipplicntion mitt ntttoo to libido by tlreso and.111
requironto o to'I'o4vn of Qticensbury Salutary Sewage Disposal ordinance.
'91unatwe of response a person Da 0
TOWN 4OF QUEENSBURY
v
BUILDING &--,-CODE ENFORCEMENT
742 Bay Road
Queen.SbUry NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 72
Location
Date - _<; / Ae rin i t
SOIL TYF/E .: San Loam C1 ay-
rc(
Results of ercolat " on Test-
( if applicable ) Rat -Minute/ nch
TYPE . OF SYSTEM-
ABSORPTION FIELD: T tal Len - h -
Length of each trenc k
Depth of trench",
Size of stone
SEEPAGE PITS : Numb r
Size - ft . x ft .
Stone size
PIPING : Size Type
Bldg . . to 'lank 14
Tank- to Dist . Box
Dist . Box to F1' eld/P * 1Openings Sealed ? oes No 'Pa rti al
LOCATT ON/SEPARATI OHS ..
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits e et
Conforms- as per Plot Plan /Yes No
LOCATION YSTEM ON PROPE T
n rcl ?r--67 Right Side
") haU�s���orobs rind orb li ue Iqw uill '
MON wo
,all cb�ccts s�ck�as hol!s�s, �cl s,trc�s,���rc�s,ctc,,
0 � � (��511 C@)CLS011�Cila�( �7clUO
I )EI
. r' �� SO!1 Ily I��aaUr , �S�a C SOt fOri�00�� �a aC�►' ,