2000-852 TOWN OF OUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Community Development = Building & Codes (518) 7614256
CERTIFICATE OF COMPLIANCE
Permit Number: P20000852 Date Issued: Wednesday, November 15, 2000
This is to certify that work requested to be done as shown by Permit Number P20000852
has been completed. ��a� " !� � ���
Tax Map Number: 523400-038-000-0002-017-000-0000
Location: SULLIVAN Dr
Owners EMMA K ZEMANEK
Applicant: EMMA K ZEMANEK
This structure may be occupied as a:
By order of`Gown Board
Septic Alteration Residential TOWN of QUEENSBURY
Director of Building & Code Enforcement
TOWN OF QUEENSBUR.Y
742 Bay Road, Queensbury, Nei' 12804-5902 (518) 761 -8201
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Community Development - Building St Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20000852 .Application Number: A20000852
Tax Nlap No: 523400-038-000-0002-017-000-0000
permission is hereby granted to: EMMA K ZEMANEK
For property located at: SULLIVAN Dr
in the Town of Queensbury, to construct or place
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. Tune of Construction Value
Owner Address: EMMA K ZEMANEK Septic Alteration Residential
C/O KATHLEEN E WILLIGAN
' 13 VAN DYKE DR. N. Total Value
DEFREESVILLE, NY 12144
Contractor or Builder's Name j Address Electrical Inspection Agency
Q'UEENSBURY SEWER
JAY SWEET
Plans & Specifications
2000-852
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
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$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday, November 15, 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 16
f Que sbu ed , November 15, 2000
S1GN1:D BY for the Town of Queensbury.
Director of Building & Code Enforcement
Application for Permit - Septic Disposal Systenn
Town of Queensbury 742 Bay Road Queensbury, NY 128o4 (518) 761-8256
1 . OWNER. INFORMATION:
......_..............._._._ ...................................
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Location of installation: �Ilr� SJ_� J� �t +wee Use
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Tax Map No. / 1 5> i '`f'' File Permit N joy,
Fee Paid
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Owner's Name:
Address: ;2 %
2. INSTALLER'S NAME : _(Du efe � c T,c�C sik &e PHONE NO. 3:� 32-',f'
3. RESIDENCE INFORMATION: (circle year of'dwelling, indicate 4 bedroom(s) and multiply # of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House; No- of Bedromns x Computation - Total Daily plow
1980 - 1991 x 130 gallbdttn = � �� � � y C
1991 — present x 110 gallbdrm = C
Garbage Grinder Installed yes l no rA0NOV 0 7 2000
Spa or Whirlpool Installed yes I no TOWN OF QUEt;N5BUP940
BUILDING AND 66(5:
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
TovpMDhv Soil Lqaturo Qround Water Bedrock or I ervious Material Domestic W t r Su 1
1 sa at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
�% slope other from any septic-system
depth: absorption is /cro ft.
other
Percolation Test: (To be completed by lice ed professional engineer or architect)
Rate: :4 : minute ,perincA *. r_ ! -''Z::
5. PROPOSED SYSTEM: For New, Cansttruction: All individual sewage disposal systems must be designed by a licensee}
professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tankand peach Field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: ,gallon (min. size 1, 000 gal)
Tile Field: each trench ft. Total System Length: fl:
Seepage Pit(s): number of size of each: _ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: J 2 length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: I 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
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
,—, ® � _ /
81goa Areesp sible person Date
I,
TOM OF QUEENSBURY �r 13UILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name V d1 .c ��srvti �35�
Location
Date -' ermi t # i
SOIL TYPE(Sand- oam-Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tota ength
Length of each trench Z
Depth of trenches 4/ 1
Size of stone 6-
SEEPAGE PITS : umber-
Size - fto x ft .
Stone size
PIPING : ize Ty e `
Bldg . to Tank rRea
57
Tank to Dist . Box
., 5—
Dist . Box to Field j '
Openings Sealed ? Partial
LOCATIONASEPARATIO
Foundation to Tank .� feet
Foundation to Absofeet
Separation of Pitsfeet
ltoeQ
ConforTns as per P1 Plan a No
LOCATION OF SYSTEMPRO;
one )
ran near - Lefght ide
e Front - Mid
CONMENTS :
SYSTEM USE APPROVED : No
Arrived:
Departed : i
Building Inspector
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCE[+IENT
742 Bay Road
Queensbury NY ._12804
(sis) 761-82%
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
C �2W
r
Location � C- • � � L �A �LC 61 t
Date Z �1 Permit #
SOIL TYPE: Sand- Loam- Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS : Number- ft .
Size - ft . x
Stone size _ Szze YPe
PIPING:
Bldg . to Tank
Tank to Dist . Box
Dist . Box to Field/Pit
Openings Sealed? Yes No Tirt7a7
LOI:A-rxbK/SEPARATIONS 1 feet
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits
Conforms as per Plot Plan �- e� s No
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rear - Left Side - Right Side
Middle Front Middle Rear
COMMENTS: Z> I
60
SYSTEM USE APPROVED : YES N
Arrived:
Departed: J `
Building Inspector
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