1999-760 Certificate of • Compliance
Town of Queensbury
Warren County,New York
Date
idecenuoer 9 9
This is to certify that work requested to be done as shown by Permit No. „„ •
•
has been completed.
This structure may be used as a •
st.; TIC ALTERATION
Location
9 r:ITA-2,1'1N1.-112V'r 4-C.T1
Owner
STREETER, MARILYN M.
By Order Town Board
TAX MAP NO. 7 2 -6-8 TOWN.OF QUEENSBURY
(Lyle,
Director of Building & Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 9 9 7 6 0
TAX MAP NO. 72 . -6-8
Permission is hereby granted to S TREETER, MARILYN M.
Owner of property located at 10 GREENWAY NORTH
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 Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
10 GREENWAY NORTH
QUEENSBURY, NY 12804
Contractor or Builder's Name:
BOB HAYES EXCAVATING
Contractor or Builder's Address:
696-2733 OR
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
25 December 14 2001 -
$ 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.)
14 December 1999
Dated at the Town of Queensbury this Day of
SIGNED B for the Town of Queensbury
• Code Enfor ment Officer
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: (Pbf File Permit No.�9
Tax Map No. 7 2/ q /
• Fee Paid ,c
Owner's Name: /-s�J L$',(J .s-,Wi f fl
Address: /0 6,d- )Gur9.y Ai.
2. INSTALLER'S NAME : 1, 2) bli->95S' £XC 1), 77, 4 PHONE NO. c 96 2-7 2
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older -2 x 150 gal/bdrm =
• 1980— 1991 x 130 gal/bdrm = .,�,,b a
1991 —present x 110 gal/bdrm = ,
Garbage Grinder Installed yes / no '� DEC `= 1999
Spa or Whirlpool Installed yes / no TOW'$G,.O`z.k' ` ``i
BUELDJ\1 3 AND CODE
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
To•o l ra s h So' ature Ground Water. Bedrock or I •ervious Material I: e tiwj _, ater Su•.1
Fl sand at what depth. at wh .t depth
Rolli g oam feet ,'-/A feet `well munici/t
ope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
• 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: /OOO gallon (min. size 1,000 gal.)
Tile Field: each trench ft. Total System Length: ft.
,d/a- / IE�r1
Seepage Pit(s): number of ek I size of each: C ft by ft
Size of Stone to be used: # 3 / depth or thickness 2_ feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
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, 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.
7 a . -a / /1 Aq
Signature of responsible person -ate
1 / II---
' TOWN OF QUEENSBURY • cccc
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name . lIc_-( -'
Location ,t'i�,�x 0
�'
Date ! 94 Permi i -7bU
SOIL TYPE: tiar141 Loam-C1 . -
Results of Percolatio; Tes C
(if applicable) Rate inute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each 'tren h
Depth of trenches
Size of stone
SEEPAGE PI S; Nu ber-
Size - ft.
Stone size a
PIPING: S,iz�� C.491/0
e
Bldg. to Tank
Tank to Dist. Bo.
Dist. Box to Fie d/Pit . r' _ '
Openings Sealed? Yes No Partial
. LOCATION/SEPARAT ONS:
• Foundation to Ta•• k. ,C. .feet
Foundation to 'Ab .orpti on •.. j f iet .
Separation of Pi: s ,0,-feet
Conforms as per lot Plan No
LOCATION 5YST R..ON PROPERTY
(circle- )
Front Rear - LeftSide - Right Side
Middle -ro '. - Middle Rear.
COMMENTS:
•
SYSTEM.USE APPROVED:/ (' YES NO
Arrived: -3.LLi
Departed: i'`I , - VP-42..--'//'
oii;L 1jn® Inspector
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,. pG,L0-, ,
shown on this document. I also represent that I have
personally measured the distances set forth on the diagram." -Pkar)
. 7-"itelii, „A;a4 /z.-__/,f /-q_
SIGNATURE DA E
/ O11 r 'r'5s- /7;,
99760 72 .6-8 •,.
I. STREETER, MARILYN M. ' • :. �—
. 10-.GREENWAY -NORTH :; 1 On-
SEPTIC'"ALTERATION -.0 1 C
®cC i : 1999
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REVIEWED BY At /t ,
DATE ..... 1? IM '._.._. �..