2000-652 TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761=8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20000652 Date Issued: Thursday, March 15, 2001
This is to certify that work requested to be done as shown by Permit Number P20000652
has been completed. a06
Tax Map Number; 523400-076``"wOOO-Ol0O1-021-4fl4-0000
Location: 8 SHERWOOD Dr
Owner, JACQUELINE MC CANN
Applicant: JACQUELINE MC CANN
This structure may be Occupied as a.
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building & Code reerut
TOWN OF +QUEENSBUR.Y
et 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20000652 Application Number: A20000652
Tax Map No: 523400-076-000-0001 -02 1 -000-0000
Permission is hereby granted to: JACQUELINE MC CANN
Owner of property located at: 8 SHERWOOD Dr
in the Town of Queensbury, to construct or place a Septic Alteration Residential
at the above location in accordance with 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 Address: JACQUELINE MC CANN
8 SHERWOOD Dr
QUEENSBURY, NY 12804
Contractor or Builder's Name 1 Address Electrical inspection Agency
CONDONS SEPTIC & DRAIN SER
Type of Construction : Septic Alteration Residential Value : S
Plans & Specifications
2000-652
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday, August 28, 2002
(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 Town of Queensbury; Monday, August 28, 2000
SIGNED BY for the Town of Queensbury.
Directo g Co ement
Application for Permit — Septic Disposal System
Town of Queenvbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1 . OWNER INFORMATION:
�j �s _,i I ............................. ...._..,.,,..._...................................................................
............
_ �7 3Tye��} (.ld 8 0( „ ieq Office Use
Location of installation: -�
/ !
File Permit No 7
Tax Map No.
/Y Fee Paid ram'
Owner's Name: rL C l ,
Address R,49 0o(
2. INSTALLER'S NAME f V �I PHONE NO. 2w,�
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 I50 gal/bdnn = �
1980 - 1991 x 130 gaVbdrm = _ ,, : •
1991 — present x 110 gal{bdrm =
Garbage Grinder Installed yes no " AUG 2 8 2000
Spa or Whirlpool Installed yes { no
4. PARCEL INFORMATION: (circle applicable information &. indicate measurements)
TonclaralRby !fir W 0-mund-w0pr H0 rock__o_jWp.Qryious Matg"i Dom atgr�5upPly
•fat s at at depth crt W1 ri depth rrerriei
]?oiling loam Meer feet well
Steep slope clay i,fwell; water supply
slope other from any seintic-system
depth: absorption is ft.
other
Percolation Test: (7brr be completed by licensed professional engineer or architec)
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: IL35Q �a~�o�n (m size 1, 000 gal)
Tile Field: each trench _ �fl. Total System Length: 60 fl.
Seepage Pit(s): number of size of each: ,f?. by ,ft.
Size of Stone to be used: It / depth or thickness feet
Bed System Size: x
Altim2stive System: length an&or size ,I' 0�ee'l sod S
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons / TOTAL Capacity: gallons
Nate: 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
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
lam'
Signature of responsible person Date
k
M
TOWN OF QUE]lSBURY
BUILDING AGODE 'ENFORCEMENT
742 Say Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name {' t
Location
Date Permi t f
SOIL TYPE: Sand- Loam-Clay-
Results of Percolation Test-
; ( if applicable ) Rate-Mfb ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tot�el Length
Length of each trench.'
Depth of trenches
Size of stone
SEEPAGE PITS : Number
Size - ft . x t .
Stone size
PIPING: Size "Type
Bldg , to Tank
Tank to Dist . Sax
Dist . Box to Field/P 4- —
Openings Sealed ? Yds No a' rtial
LOCATI ONN/SEPARATIOMNS :
Foundation to Tank feet
Foundation to Absorptign feet
Separation of Pits feet
Conforms as per Plot Pl ` names No
LOCATION OF SYSTEM ON P OPERTY:
( circle one )
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
C+DMIME
i
i
SYSTEM USE APPROVED : Y NO
Arrived:
Departedi
di nspawf r
OR Net v4r4PIIA�f
WE C R ED
OR 5 200,
TOWN OF
Sulu,, I laX
tit have seen or observed l
004
all o ects such 0 or believe I
show as houses saw evid:nce of ��. ' C f =
n on this document � wells. #reel
AersQnall gent. I also r fences, c.,
Y measured the distances resent that I
`� have
set forth on the dia
SI�NAI•URE —.,... 8 /Y,L, D� 9 ,
dram.
DATE PEFC /
44R4
� D
r0
OP
S#YU)W.P Dk, dTfl)vEwcod Of
TOM OF QNlEENSBNIRY
ILDIN6.. & CODE ENFORCEMENT
742 Bay Read
Queensbury NY 12804
(518) 7161-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name - '�.. b
LocatiorP
Date Permit # C D�,,
SOIL TYP San m-Clay-
Results of Perc lation Test-
( if applicable ) Rate-Minute/ In h
TYPE OF SYSTEM:
ABSORPTION FIEL Total Lang
Length of each t ench
Depth of trenche 4;7 Ayr
Size of stone
SEEPAGE PITS : ber-
Size - _ ft x ft .
Stone size
PIPING: - izeType'
Bldg . to Tank 0Eye.:3
Tank to Dist . Sox ' %
Dist . Box to Field/ it it ,�} �ja �
{Openings Sealed ? No art a
LOCATION/SEPARATION .
Foundation to Tank L Cj _ feet
Foundation to Abso ion _ feet
Separation of Pits feet
Conforms as per P of lan des
LOCATION OF SY ON ROPERTY :
( circle one )
Front - Rear - ight Side
Middle Front iddle R ar
COMlENTS:
3 A
f
SYSTEM USE APPROVED : Y :.S 0
Arrived:
Depart
din ns r
r
3
P ?.I q6 3
t tj
M _i}" 1
z
1.L�1
w 4 r
5 's
' o ro a
06
} 7 S
0 �Z' M .
W
_
2: v � O
S � U
a
"I have seen or observed, or hdiene I sarr eYidence
all objects such as houses, welly % °�'41 AUG � � 2�D0
sek
hown on this document I also reP�ntSg I here
Personally measured the distanees W hbaM on I* & -
FPS
SIGNATU
DATE
CL
C)
U
W
UJ
s Pep Q100 e/ 0 f tAw ocr*� 64Avto) rddiv