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2003-727 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: P20030727 Date Issued: Wednesday, September 03,2003 This is to certify that work requested to be done as shown by Permit Number :. ' P20030727- has been completed.._.��...,.....�... - . .u+. r�. - Tax Map Number: 523400-309-006-0001-040-000-0000 Location: 23 NATHAN St Owner: CARL&LINDA WINCHELL Applicant: CARL&LINDA WINCHELL This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code nforcement TOWN OF ,QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes.(518)761-8256 ' BUILDING PERMIT Permit Number: P20030717 Application Number:. A20030717 Tax Map No: 523400-309-006-0001-040-000-0000 Permission is hereby granted to: C;ARI,&-LINI)A WINC;HFI,I, For property located at: 23 NATHAN St 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 Unifortri Building Codes and the Queensbur'q Zoning Ordinance. - Type of Construction Value Owner Address:- CARL&IINDAVINCHELL 23 NAPHAN St Septic Alteration Residential Total Value - QUEENSBURY,NY 12804 Contractor or Builder's Name'/ Address Electrical Inspection Agency SANITARY SEWER DAN DRELL.OS PO BOX 224 GLENS FALLS NY Plans&Specifications 2003-727 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES Friday;September 03, 2004.. 6f a longer period is required,an-application for an extension must be inade to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at a To ' 'of Q n esday, September 03,2003 SIGNED BY for the Towii of Queensbury. Director of Building&Code Enforcement Application for Permit Septic Disposal System Town of QUeensbur•y 742 Bay.Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: ----- Office TJse Location of installation: 2,3iVA' ! A"y1.1 J Tax Map No. / / I File Pernut No.y t3 Q W �Owner's Name: i Fee Poi r. Lj _....._..,_....�.Address: 2-2AJ Aay 1S''71rf e,�1' ;Y._�...-200.3._......_.._,. TOWN 01= 2. ZNSTAI,LER S NAM£ PHONEN` U�3Y 3. RESIDENCE R WORMAThON: (circle year of dwell ,indicate#bedroom(i) and multiply##of bedrooms with applicable gallons per bedroom to equal total daily flow) 'Year of House: No of Bedrooms x Computation — Total Z7ai1y Flow 1980 or older x 150 gal/bdrm = 1980— 1991 x 130 gal/6drm = G 1991 —present x 110 gal/bdrrn = Garbage Grinder Installed yes / no`1 Spa or Hot Tub Installed yes a / no a 4. PARCEL INFORMATION: (circle applicable information fir indicate.measurements) Tonoy-raphy So' Nature Ground.Water Bedrock-or Im ervi us Material D2Mestic Water Supply Flat sand at'what depth at what depth municina1 Rolling corn feet feet well Steep slope clay if well;water supply —/o slope other from any septic'-system depth: absorption is ft. Percolation Test: ( o be completed by licensed professional engineer or architect) other Rate. minute per inch j S. 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 eac Garbage Grinder,Spa or Vdltirlpool Tub. �i� �_, �� 11 Septic',lank: 1 Q20 gallon(min.size J,000 gal,) ° `�� Tile Field: each trench- ft, Total System Length: a�y o fi. Seepage Pit(s): number of 81 1 A, size of each: __ Y, by ft. Size gf Stone to be used: t# / depth or thickness feet . Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK.SYSTEM: (if required) Number of tames: / 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 &RS FORMATION 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 re a regulations th r spect to this application and agree to abide by these and all 5 require nts f the Town u nsbury S ary Sewage Disposal Or cc. ig a ure of ress ons ble person Date Xva rr_:r_i 9111 COOZ/TO/LO COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC. Main Office 176 Doe Run Road Of Manheim, PA 17545 MUNICIPAL CERTIFICATE a ELECTRICAL APPROVAL No Permit No.�1J�^+��1 1W**�•�1i•1 N■1 R}#}R##}#M##}}1##}}RR#1#N#fN♦ RR1NiR#liiiiR! !##}##}##}#If►Ril} C44ar,, No. 4f 104 { N { ## f#I#iNfiRf}NNil{NqN,lfi#f#i#H#}i}f#YRi#i}iffyf}Y}Y}lNipipN Location IR#!! f}fff!#RHff#ff}ffp4ff#1NNR#4i1##/i#R }}}#R}#}Ry#NRfNfi♦fpRf#NR}ff#f#f#fip{ffff#llfR/}#f4}#RFf##}#}fiI FA fifH4fffffff#fffNf• HfRRfflfi#fNf#N111 Installation Consistln of �u I 1 i1# f#fRi 1#il/N!N#NfN411 #N}}}flyify#4lpf1lNYR41h{{f!!f{p##ff#fpifflNNi}#f!#i##if##N}N##1Rfif##}##}####N###R!y 4#111 fee ISO Ito feel 1}64414pi4f###{f#lgifipNif sets Igo f fbf of Nf.#iiNif.}y See yiiN14#iNp,liRi.{.Yi#{f{fl14INf1Ni141y„i####if4 woe Ito Ito f#fp4Niff##f fff{f4 f 114#fflf{ipff if ipitliifffiN4yff 4fN1{pflNiNN4ffN44NNii{NN44}fN##N..}#pNNff fff{iffNfNiN}.}}RiiNllitf4/1i11{f,ifiNf4Nyyl.{yi!♦if!li14y4l41#111lH11lf1iifpi4l#iN111piN1lN Ac "7P 0, 16 "'t, InstalledBy.,,,�.�/,Ai f.f4f##ffp#fi#NiiNfifpflifif#fi4NN4ii.ifNlff{{f Nfif iif 144NN iY#.Lief No. 111#YI#,i11,NffNNiN1#1{llpiifpi#l11i,11,if The conditions following governed the issuance of this certificate, and any certificate previously issued ii cancelled: This certificate only covers the electrical equipment and installation conditions as of date, Upon tht introduction of additional equipment or alterations, application shall he ptly made for inspection! Inspectors of this Company shall have the privile e o aking inspe tions at any time, and if it, rules are violated, the Company shall have the right to ev a his c rtificate. #>, y,/dry' � Date,,, ffi.i}iN.i#R#f i#,4fiiY4.{...iff1.#4#Iflf! INSPECTOR fppf 4i4ffiiii i.iiiN •pNN#!ff#ffiN#N###R!!#!!lffR##Rfyf41}i#fllNfif4pff!#4NR, Mamhar N 17D A 1 A V 1 Septic Inspection Report Office No.(518)761-8256 Date In ection request e sl��a a 1-U a�Tt5;� Queensbury Bu ilding&Code Enforcement 'Arrive: 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia NAME: ®RMITNO.: C`)3> LOCATION: INSPECT ON: C) RECHECK: Comments and/or diagram Soil jK. SanjQfjj��Clay Typeo �u4icip-W - I-W*R-Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench 1. Depth of trenches --.Size of� tone Seepage Pits: Number Size: x Stone Size: Piping Size Type,. Building to tank \,2, t2 Tank to -7 Distribution Box 1 t Wiet Opening S Ial Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits Conforms as_per Plot Plan %L"'Y_N Location of System on Property; Fr t Re t Right S' Middle Froi 'Middle Rear System Use Sta s: Approved Partial Approved and needs to be re-inspected,please call the*Building&Codes Office Disapproved L:tSue,Hemingway\Building.Codes.Inspection.FORMS\Septie Inspection Report.doc January 28,2003 411 O �f��� RCS v �� ®� a TOWN OF QUE NSBURY BUILDING DEPARTMENT Based o odr limited examination, complian with our comments shall not be c nstrued as indicating the plans an specifications are in full comp with the Building Codes of New State. TOWN ar QUEENSBURY BUILDING & C E T DATE a retie seen or observed, or believe I saw evidence of, -oleos such as houses, wells, trees, fences, etc., rrvn on this docume also represent hat I have soy, ify measured t . di ances t h on th diagram." SIGNAT R 2-9 b DATE