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2003-945 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)161-8256 CER" IRFIC ATE OF COMPLIANCE Permit Number: P20030945 Date Issued: Tuesday,November 18,2003 This is to certify that work requested to be done as shown by Permit Number P20030945 has been completed. Tax.Map Number: 523400-309-014-0001-020-000-0000 Location: 90 MAIN St Owner: ROGER&PAIVIELA WHITING JR Applicant: ROGER&PAAELA WHITING JR This structure may be occupied as a: By Otder of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Aitector of Building&Code Enfotcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community.Development-Building&Codes (518) 161-8256 BUILDING PERMIT Permit Number: P20030945 Application Number: A20030945 Tax Map No: 523400-309-014-0001-020-000-0000 Permission is hereby granted to: ROOTER &PAW.T,A WT-TITTNCT.TR For property located at: 90 MAIN 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 Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: ROGER&PAMELA WHITING JR Septic Alteration Residential 6 DIXON Ct Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2003-945 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 13, 2004 (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,) ens Dated at the To 0 en 4rj,_X6vember13,2003 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Applibation for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (5M) 761-8256 1. OWNER INFORMATION: ,�,;............................."................................................................................... Location of installation: Office Use File No. Tax Map No. 3D96 7 1 Fee P id�� Owner's Name: :1�ee ...................................... ............ Address: Ll 011.1�4- e-h LIP— 2. INSTALLER'S NAMES PHONE 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and mltio bedrooms with applicable gallons per bedroom to equal totalfaz y120 op Year of House: No. of Bedrooms x —Cornvutation = Total�9jft El WW '00 1980 or older x 150 gallbdrm = 1980*—1991 x 130 gal/bdrm = d4 1991 —present x 110 gal/bdrm. = Garbage Grinder Installed yes_ I no"— Spa or Hot Tub Installed yes no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Top ography Soil Nature Ground Water' Bedrock or impervious Material Domestic Water SU-onjv Flat sand 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_ft. Percolation Test- .(To be completedt)by licensed engineer or architect) other Rate: minute per inch 5. PROPOSED SYSTEM: For NewConstruction: All.I individual sewage.disposal systems must be designed by a licensed professional engineer or,architect(unless installed in a Planning Board approved subdivision). Add250 gallons to the size of the septic tank and leach field for each Garbagi Grinder,Spa or Whirlpool Tub. Septic Tank: gallon (min. size 1,000 gal.) Tile Field: each trench ft. Total System Length: Seepage Pit(s): number Of--2?— size ofeach: by ft. Size�f Stone to be used: W / depth or thickness 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. -P /v- �zrx Signature ofresponslbM peW.-on Date .• 'Tow, le Of OxIo-elASI)ILIi•V •:�t:wt:r:s untl :ietivstl;a I}i.�sl)a:.stl t.iss)z)fr:'. 11pj)omlix t: • � A•1l.'�;i)I�x''�•1'Itk�`sl, Ii'I1�;I,,I.) '. SI�SI'11It1�'1`1C?AI IMA2l•)I ILtrlti]IssN1,14 -:�...! v'!P_ft,. tN t�rrc*•cz• _;'"•""' �'``�� .. �� ,,,,r,/ rt t�•n••t _}y' ,fir' • 1�uaE Ci AV— ,� t, c•oaY1� . .} St:t.I lc. • �•-� t�tY,css�rtva s • t�)at.a� ' ?. sioN AT �'L' F�.�ZV�L1 Q g�.}�. �1•tYVl�ls"i11�LC. '27 vs^t�+ayssa........:� •" •'ice:: R V Septic Inspection Report _ Office No. (518)761-8256 Date Inspection req st recei Queensbury Building&.Code Enforcement Arrive: p ep�rt: am/pm- 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi s: d" ' NAME: �{1T tit�r� PE T NO.: LOCATION: 90 Mt�� - INS ECT ON: -- RECHECK.: Comments and/or diagram Me T an Loam/Clay of Water: ni i Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size T e Building to tank Tank to 11 3 /Pit Opening Seale Y NI Partial Location/Separations Foundation to tank Foundation to absorption z ft. Separation of Pits ft, Conforms as_per Plot Plan Y N ECB-\W:5�) N6— 1�5 �r Location of System on Property: Front Rear Left Side Right Side U Middle Fro Middle Rear system Use St us• Approved Partial Approved and needs to be re-inspected,please call the-Building&Codes Office Disapproved L:iSueHemingway\Building.Codes,Hispection.FORMS\Septic Inspection Report-doe January 28,2003 ao, p 2A( C� coo a cl �Z. h�v fe �QP C 113 cl � 4 Hof Septic Inspection Report Office No. (518)761-8256 Date Inspection reque re e' ��`G d-eV 3 Queensbury Building&Code Enforcement Arrive: U''30-a D art: a in 742 Bay Rd.,Queensbuiy,NY 2804 Inspector' Initials: NAME: r E NO.: �a'- LOCATION: l/,ty� SPECT ON: U, � RECHECK: Comments and/or diagram Soil T e /Clay T e of Water Munici a Well Water Waterline separation distance ft. Well separation distance ft. j Other wells: � -ft. Absorption Field: Total length ft. S Length of each trench ft. Depth of trenches ft. Size of Stone - Seepage Pits: Nun3ber 2L Size: x Stone Size: Piping Size Type Building to tank F t - Tank to D.i64A"*im=b= r it Opening Sealed:(]PNL Partial Location/Separations " Foundation to tank Foundation to absorption t3 ft. Separation of Pits fV Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side Middle Fr nt Middle Rear ' S s_y tem Use Status: Approved artial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\,SueHemingway\Building.Codes.lnspecdon.FORMSISeptic Inspection Report.doc January 28,2003 309.14-,1m20 Page 1 of 1 309.14-1-20 Oe ................. 92 .-A t i},tiita 'MT' � fC sx v ¢ bass x z� f 4 { s91 t flip, .f r � t `�s ( •�.,si� s•tt sa�2 r'�d, .-. ra4 ^! t III-. •¢ ��y��{QQ�� 4 t. :... :r �ca�sbar f�ngt`h�•a�w��l� iractit ��, .�,� r ppgm x IM Town of Queensbury 742 Bay Road Queensbury,AT. 12804--5902 ddI have Sern ill ar ',behieve I SRI evidence of,�- yi�jl.]�Yci ��;; ..•� r=: YtCr':t, it v d —ni trees, ferices, etc., 1p ! cld represent ttiilt I have :: dis�ances set forth on the diagram." t- w DATE 5 t .� ¢�',,j C7 .� by 4 a 4tr BUILDING Q DREVIEWED BY � T DATE � 11/10/2003