2000-432 Certificate of Compl iance
Town of Queensbury
Warren County, New York
i
i
Date .Tube 20 , 2000
in
2000432
This is to certify t at rhark requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION s
This structure may be used as a
Location
- - — 74 t�IA I N S T .
Owner STEVES , PHILIP & TRINA
TAX MAP NO , 134 . - 5 - 7
By Order Tawas Board
XwGPMN OF EE
Director of Building & Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury, NY 12804
County of Warren (518) 761-8256
- Building Permit No._ .
Permission is hereby granted to
Owner of property located at '
in the Town of Queensbury, to construct or place a irn — A�� I
tJfl
at the above location in accordance to application together with plot plans and other information hereto filed, and
appiroved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owrner's Address:
61U; 9" , I
Contractor or Builder's dame:
. at tc
Contractor or Builder's Address:
wwy ta"
Electrical Inspection Agency:
Type of Construction:
Plans and Specifications:
swtrc
Proposed Use:
$ PERMIT FEE PAID — THIS PERMIT EXPIRES
(If a longer period is required, an application for an extermoon must be trade to the Code Enforcement
Officer of the Town of Queensbury before the expiration
t
Dated at the Town of Queensberry this Day of
SIGNED Bp i e= for the Town of Queensbury
TCode Enforcement Officer
Application for Permit — Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1 . OWNER INFORMATION:
- _......_......,._,..w......
Location of installation: < '# i ct rV r Omce Use
Tax Map No, / / File Permit NCB A
Owner's Name: M1 r� — Fee Paid ��
.. ...... . .. ............ ...... . ......... .........._. . ...._..................
Address:
2. INSTALLER'S NAME
' A' � PHONE NO. r/
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 H s No. of ,H r s x Cowputation - Total Daily Flow
1980 or older �}_ x 150 gaVWnn = [ c)
1980 - 1991 x 130 gal/bdrmr
1991 - present x 110 gaVbdrm
Garbage Grinder Installed yes � / no SD
Spa or Whirlpool Installed yes I no JUN 9 2000
4. PARCEL. INFORMATION: y r�u+�v
(circle applicable information &. indicate measurements)�`�' ��-��"-.__'_, t7. �
r un at r Bedrock or lm�eryigrs Material i7oinestic Water Supper
Flat wand at what depth at w epih rnrrtticipal
oiling mfeet feet well
Steep slope clay if well, water supply
�S5 slope other from any septic-system
depth: absorption is fI,
Percolation Test: (To be completed by licensed professional engineer or architect other
,Rate: minute per Inch
5. PROPOSED SYSTEM: or New Construction: All individual sewage disposal sysicros 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: gallon (min, size 1, 000 gal,)
Tile Field: each trench f?, Total System Length: fI.
Seepage Pit(s): number of size of each: ft, by f,
Size of Stone to be used: N / depth or thickness / _ feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: 1 Size of each; gallons I 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, 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
requiir,e�m10�ents o7thwn ofQueensb ryr Sanitary Sewage Disposal Ordinance.
000P
gnature of responsible person Date
r TOM OF QUEENSBURY
By I LD INr a CODE �adRC0"T .
742 Bay RY 12804 100
Queens 518) 7
� xs) �61-8255
SEPTIC O SPOSAL SYSTEM INSPECTION
Name
Location ' -�~ "
Dateermi t #
SOIL TYPE : Sand-Loam-ClaY-,��__-Results of Percolation T st-
( i f applicable ) Rate-Mi to/ In. �h
TYPE OF SYSTEM:
ABSORPTION FIELDt Total Length
Length of each trench
Depth of trench
Size of stone Numbe
SEEPAGE PITS : ft .n ft .
Size - s--a
Stone size _ Size ype
pjPIKG
$1dg . to Tank
Tank
-�Ae� l�' t
�, arta a
Openings Sealed? es
LOCATIONISEPARAT feet
Foundation to Tank feet
Foundation to Absorp ion �- et
'Separation of Pits lan es o
Conforms as per Pla P PROPE
LOCATION OF SYSTEM 6
( circle one) _ Right Side
Front - Rear - L i ddl a dear
Middle Front
cOPKENTS
SYSTEM USE APPROVED - YES �O
Arriv e
Dep
2 ding pector
"I have seen or ob erved, or believe I saw evidence of, 000 34 . __ 5 - 7
all 10 ects such a5 houses, wells, trees, fences, etc., STEVE S , PHI LI P & TRINA
;hU s4 Ora this d o c i !lent, 1 also represent that I Rave 74 MAIN ST .
d the d€stances set forth on the diagram."
asu
DATE
1.
�
JUN 1 9 oQ�
ri
Tr/ r�
- +QU RY
BE ILDIN
{ ��r
REVIEWED BY
DATE
TY ,!