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2002-652 TOWN OF QUEENSBURY ���r 742 Ba Road ueensbu NY 12804-5902 518 761-8201 Y ,Q rY, � ) Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20020652 Date Issued: Friday, August 09, 2002 This is to certify that work requested to be done as shown by Permit Number P20020652 has been completed. Tax Map Number: 523400-289-007-0001-065-000-0000 Location: 564 MOON HILL Rd Owner: MARK DICKINSON Applicant: MARK DICKINSON This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY r.— „O 4 id' Director of Building&Code Enforcement TOWN OF QUEENSBURY '� 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 f � *0,0 ri L E copy Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020652 Application Number: A20020652 Tax Map No: 523400-289-007-0001-065-000-0000 Permission is hereby granted to: MARK DICKINSON For property located at: 564 MOON HILL Rd 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. Type of Construction Value Owner Address: MARK DICKINSON 564 MOON HILL Rd Septic Alteration Residential Total Value LAKE GEORGE,NY 12845 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2002-652 Septic alteration per plot plan and specifications. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,August 05,2003 (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 Qu ns ; f 4o day : u 1, ' .,2002 GlAtki(SIGNED BY \ for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 -1. OWNER INFORMATION: ••-- f Office Use Location of installation: -) T File Permit No. Tax Map No. / / ''` 7)( �'" Fee Paid Owner's Name: /' f</ ,/e 17? G '`�� Address: 6 7" 0 Q, I f /f P 13 -fisw-Li-444u -4/f ("\-tA.k.. et.t) �,� / '' '2. INSTALLER'S NAME : � -� 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 Bedrooms x Computation = Total Daily Flow 1980 r older x 150 gal/bdrm = 2 6-z1 x 130 gal/bdrm = 1991-present x 110 gallbdrm = Garbage Grinder Installed yes_ /O Spa or Whirlpool Installed yes 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply at what depth at what depth mu i cipal o ling oam feet feet (CP Steep slope clay if well;water supply _%slope other from any septic-system depth: absorption isle ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: , 3 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:,/`Z gallon(min. size 1,000 gal) Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s): number of size of each: ft. by f t~ l�ct� J 7002 Size of Stone to be used: # / depth or thickness feet Bed System Size: �- - Alternative System: FL E'-6✓ 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. Sig t re f responsible person Date COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL ?ermit No. Cert. N C 79402 Cut-in Card No 02 ‘3� Dwner ��--// � f 1i gO , /1 �f Location .c..�•-6.u mo) All t L �,�o`'' ""'u•7 Installation Consisting of .rifl 1 '' e-4Ve-f GAS Installed By „ . 5410` e Lic.No. The conditions following governed the issuance of this certificate,and any certificate previously issued is cancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon the introduction of additional equipment or alterations,application shall be promptly made for inspection. Inspectors of this Company shall have the privilege of ma , inspections at any time, and if its rules are violated,the Company shall have the right o e oke erti9cate. Date g". �� INSPECTOR ... .... Member N.F.P.A.,I.A.E.I. 4 .4' -, J TOWN OF QUEENSBURY BUILDING A CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Dl1 .) Location cT(U'- mac, Vie 'f SO Date - Permit # %°": ---Ga52. SOIL TYP : San am-Clay- (,0 Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length ; ‘ Length 2 of each trench /Ad 10 lai Depth oir,, trenches 1, - KQ Size of Stone SEEPAGE PITk: Number- Size - ft. x ft. Stone size ' ..' PIPING: Size Type Bldg. o Tank 'l , bV4 Tank o Dist. Box Dist. Box to Field/Pit ' t Open ngs Sealed? Yes N artial LOCA -CH/SEPARATIONS: Foundation to Tank 10 feet Foundation to Absorption 31:,,, feet Separation of Pits feet Conforms as per Plot Plan s�/No LOCATION OF SYSTEM ON PROPERTY- (circle o Front - ear eft Side - t Si Middle - Middle Rear COMMENTS: 1) /-tA, i b 0 To t,c_,p ZDQE2—\ -'1‘ ?OtAV .1 Pt ' ' SYSTEM USE APPROVED: 010 0 Arriv• . . C l,i„, Depa ed: laiWirAi ' '• ALA lid ng -nspec or TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Dtc -/ ► O o Location, 4 r o,. k-\t 1-v R Date Permit # _'Lapp ras- , 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 st e SEEPAGE PITS: Numbrr- Size - ft. /x ft. Stone size v ,' PIPING: \ / Size Type Bldg. to Tank , t Tank to Dist. 1'ox Dist. Box to Fieljd/Pit Openings Sealed? ' Yes No Partial LOCATION/SEPARAT ONS: Foundation to Ta k feet Foundation to Ab orption feet Separation of Pi s feet Conforms as per POot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: -S) c ko R\ 6_V,_ PkQ41 k/ 9 SYSTEM USE APPROVED tk 4ES' ?v 0 Arr.' ed. '..,IP D? eart- f�: •A! c ,'10 /'.A Bu Iding Inspec o i JUL 22 2002 7: 58RM HP LRSERJET 3200 p. l NACE ENGINrEERING, P.C. 169 Haviliand Road,Queensbury,NY 12804 Phone-518-745-4400 Fax -518-792-8511 July 22,2002 Job#49090 Mr.John O'Brien VIA FAX—745-4437 Queensbury Building&Codes Dept. Town of Queensbury 745 Bay Road Queensbury,NY 12804 RE: Mark Dickinson replacement Septic System 564 Moon Hill Road,Queensbury Dear John: At the request of Mr. Jay Sweet f Queensbury Septic Tank Service, I performed a percolation test for the replacement septic sys m at the Dickinson residence on Moon Hill Road in the Town of Queensbury. This test was pe ormed in side yard at within the area for the proposed leach field. The soil consisted of sand topsoil over a very fine sandy loam. A layer of cobbles in this very fine sand were encounter at about 24 inches. The stabilized percolation rate was 5 minutes,30 seconds. Please call me if you have any qu tions. Sincerely, Thomas W.Nace,P.E. cc: Jay Sweet t Li , ,,..„ ,,,, ,L, s.L.,.. z .. '.:(-::, ['..:' ',: - ,, ,:,,, _ o ___ , _ _______:__ , e,,_ /...Tho zi. DATE 1 So -\\ <- SG r - TOWN OF QUrEN'• I TRY �s BUILDING • •,f� PT. REVIEWED BY Id rl DATE MIBRYNT f 7 v 3.. ,,. ,, J, --a y-,0 ci . 7-,,, 47 ) c3 " "d____) ______. . c) 0 0./ ;::, , __ . \ , V 1 )J-Di,.., - 1 l Ja--f-v-640--k-4 , _ _.