2000-404 C t f t- e of, Comp la,%^ ce
er i itca
'down of Queensbury
Warren County,New York
June 2000
Date 7=
This is to cortify that worm requested to be done as shown by Permit No.
has been cora�leted,
SEPTIC ALTERATION
This structure may be used as a
41 HEINRICK CIRCLE
Location
Owner C'K3E, JCHH & THEREA
TAX MAP NO, 90 o -4#16 B Order Town ward
y �
OF UEE
Director ofBuil ing& ode:enforcement'
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 2000404
TAX MAP NO. 90. -4-16
O'KANE, JOHN & THERESA
Permission is hereby granted to
41 HEINRICK CIRCLE
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.
4-"rh-,$iMq9ek CIRCLE
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 June 12 2002
PERMIT FEE PAID—TFIIS 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.)
June 2000
Dated at the To Queens this Day of
SIGNED BY for the Town of Queensbury
Code Enforcement Officer
Application for Permit—Septic Disposal System
TOW11 of Qtteensbttly 742 Bay 1?oad Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
..............:.:....................................._...._.......................
� Office Use
Location of installation: Y( � Ic C"f '•
File Permit No., j q 1
Tax Map No. / / E
F Fee Paid ,
Owner's Name: [
[..............._.._.......................
Address: I - l�.r c G
2. INSTALLER'S NAME : �^ �Q�s z �- 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 Bedrooi is x Computation — Total Daily Flow
980 or d`T� x 150 gal/bdrm
19 �91 x 130 gallbdrm �
1991 present x 110 gal/bdrin
JUN 0 0 200 Garbage Grinder Installed yes 1 TOVVV
Spa or Whirlpool Installed' yes_ I B�'IC OF Q, OI,GOD R�'
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Topography Soil Nature Ground Water Bedrock or h-n ervious Material Dons is Water Supper
!at seta at what depth at what deptta mzuiicilr
Ro ling oam, feet feet well
Steep slope clay ifwell; water supply
____%slope -other from any septic-system
depth: absorption is ft.
other _
Percolation Test: (To be completed by licensed pr(yessional engineer or. architect) .
!fate: minute
.pet inch
5. PROPOSED SYSTEM: For Neiv Construction: All individual sewage disposal systems must be designed by a licensed
professional engiineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to tine size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank: l e es gallon (min..size l;000 gal.)
Tile Field: each trench, . ice fT Total System Length: -0,�y jt.
Seepage Pit(s): number,of size of'each: __ft. by____f1.
Size of Stone to be used: f! 1 depth or thickness feet
Bed System Size: x
Alternative System.
y .0 L7ty�j-��� length dndlor.size
ti. HOLDING TANK SYSTEM: (if required) cc �1i l3 }cE, 4.
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 the Code of-the Town
of Queensbury,,ahy 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.
e?_
srjqq uye of responsible person Date
COMMONWEALTH ELECTRICAL, INSPECTION SERVICE, INC4.
Main Office 176 Doe
Run Road - Manheim PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Board No.1iiN ri•iiriirrr iii triiii+of Certo N1 65260 Cut-in Card Not I+iiiNIMN#/4ir+i ilHii/llllliiHi
VC
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Installation Consisting of Iooriifftrtrfroiffff/fR#firs}f4 ifRrf4#iiffiiftffit#N/1 1o11f#Iliffirf rfri„liorfrfirolt##iofoofooritpfioofrirfrriri
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IF
Installed By,,,,,,
1041.1oor • ff f it 4 4rffr i!#Ruff It !toiifMitort#•iroorrsiftittoLie, N!ray)'f frrfftt4frii
I
The conditions following governed the-issuance of this certificate, and any certificate previously issue is
cancelled.
This certificate only, covers the electrical equipment and installation conditions as of dater Upon the
+ i
introduction of additional
equipment or alterations, application shall he promptly made for inspection,
inspectors of this Com ay
n shall have the privilege of makin ' spections at any time, and if its
p p
rules are violated, the Company shall have the right to rey9keLthis fIlcat t
Date,61
ffrf#i�ifrtofrffitri lrt000fRlf Riif rft11o1#!1 INSPECTOR ++ r.offo rrf.Nroriirtiffof.Rrtiofrtrr l#f#irf �rifoorofffrrtrifoofRiiooi
member NA RA., LA Ef
-Uobm OF QuEzEKSBURY _
Bt1ILDIPfO - b CODE` ENFORCEMEN-F
742 Bay RcDcxa
Quee�asb¢ar-y BY 12aO4
(518) 761-825+rt-r
SEPTIC DISPOSAL SYSTEN INSPECTIOM
Name
Loca -ti on
D a t e cc>_ — ` 7 — ` :3 e rrn i
SOIL TYPE: and^.I�oam- Cl ay-
Resul is of Percol a -ti on Test-
( if" applicable ) Rate-Minute/Inch
TYPE OF SYSTER05e
ABSt]RPTI O# FI EED _ o t,a l Length ,
Length of each re-n. h
Depth of trench s E S _ '
Size of stone �-
SEEPAGE PI—VS: N mbc -
Size - -F _ ft _
Stone size
PIPING : Size =Tarp'
Bldg _ to Tank _ �C �l�
Tank_ to - Dist _ - Bc
D st _ BGx to F i el d/Pit ,a �Y �� ► ���1
Openings Seal ed ? Yes No Parti al
�.00A-FI Of4f Z S EPARAT` OYES :
Foundati on to Ta k -_' .� fee t
Founda-ti on to A sorpti one" feet
Sepa3--ati on of:' P is eet
Con-Forms as pe Pl of Pl an es,__ ..�
LOCATIOf4 OF SY TEIM ON PROPER"f
( c -i rrcl e one )
Fr-ant - Rear - Le_-F - Right Side
Mi dd l e F iron t i ddl e Rea r_
COh�fERtTS : �
SYSTEM USE APPROVED _ YES NO
A r-rz eve k.
D eP a 1r
TOWN OF Q UEENSBURY
BUILDING A CODE EHFORCEMEN-F
742 Bay Rocgja
Queertsbaary MY XZB04
SEPTIC DISPOSAL SYSTEN INSPECTION
N amen
L o c a t i on
Date fp - Permi t # � _
O {
SOIL T'!P"PE_ Sand- oam-Cl ay-
Resu7 is of Perco7 ati on Test-
( i -F applicable ) Rate-Mi nutefInch
TYPE OF SYSTEM=
ABSORPTiOiN FIELD : Total Length
Length o-F each trench
Depth of` trenches
Size of stone
SEEPAGE PI-US: N umbe r-
Size - ft _ x ft ,.
Stone size
PIPING : Size Type
Bldg . to Tank
Tank to Dist _ Box
Dist- Box to Fi el d/P -i t
Openings Sealed ? Yes No Part-i al
EOCA-FIOW/SEPARATIONi S
Founda -t i on to Tank -FeQt
Founda t on to Ab sor-p t-i on feet
SQparaa ti on of Pi is -Feet
Confor*ns as per Plot; Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
( c -i rcl e one )
Fr-on t - Rear - Left Side - Right Side
Middle F r-on t - Mi ddi e Rea rr
C014IMENTS =
v�f�w
SYSTEM USE APPROVED = YE
3 d� aig a for
Y
TOWN OF QUEEN URY
TRE
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