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2001-287 ''' TOWN OF QUEENSBURY wors 2 Ba y ay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010287 Date Issued: Friday, May 11, 2001 This is to certify that work requested to be done as shown by Permit Number P20010287 has been completed. Tax Map Number: 523400-127-000-0001-001-000-0000 Location: 239 MINNESOTA Ave Owner: JOHN & CAROL DALY Applicant: JOHN & CAROL DALY This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY (-3J/1 Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010287 Application Number: A20010287 Tax Map No: 523400-127-000-0001-001-000-0000 Permission is hereby granted to: JOHN& CAROL DALY For property located at: 239 MINNESOTA Ave 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: JOHN& CAROL DALY 26 OHIO Ave Septic Alteration Residential QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name/ Address Electrical Inspection Agency Plans &Specifications 2001-287 SEPTIC ALTERATION(REPLACING TANK)AS PER APPLICATION $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday,May 11,2003 (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 nsburyi Friday a 11,2001 SIGNED BY if for the Town of Queensbury. Director of Building&Cos e En •'cement • • • ' Application for.Permit—Septic Disposal System Town of Queensbui y 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: - Location of installations 3 I -aze -iVe. /��f, Office Use Tax Map No. i�7 / / / File Permit No. • • Fee Paid § o) Owner's Name: JD ff/V PA-y Address: / 0 l-1/r� fy 1/E 2. INSTALLER'S NAME : J D pm p4.67 • PHONE NO. rI ?i 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate II bedroom(s) and multiply II 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 I x 150 gal/bdnn = 7_ 1980;- 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes / no Spa or Whirlpool Installed yes_; / no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) • �4D9 oil Naty_L9 _D.S9uPSMIO.r_ 1 cd.rock_QdinuoL i4 LMAktAr_kill Domestic Wa.t.4r.Supnly 1"Yat sand at what depth at what depth ►municipal , Rollingin l�o 2.6L7© feet 7 feet well Steep slope 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 it licensed professional engineer or architect (unless installed in a.Planning Board approved.subdivision). Add 250 gallon§to the size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. • Septic Tank: t/ 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 ft. Size of Stone to be used: ll / depth or thickness 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. lgnature of r ponsible person - Date �--> TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 0k,Y\ K.C)..\ Location 0 24i r Q� -Pv-) Date lQ a Permi t SOIL TYPE: Sand-Loam-C ay- Results of Percolati . Test (if applicable) Rate Minu -/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Th . Length Length of each tr; h Depth of Irene- es Size of stone SEEPAGE PITS: Number- Size - ft. x ft. Stone size PIPING: ize Type Bldg. to Tank 5r I(J Tank to Dist. Bo)' Dist. Box to Fie d/ Openings Sealed? Yes No .Partial LOCATION/SEPARA ION . Foundation to Tank / feet Foundation to Absorption . _ fe.et . . Separation of Pits eet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERT • (circle one) Front - Rear - ( - Right Side Middle Front - Middle Rear COMMENTS: .- 1 /0 Ice A3( • SYSTEM USE APPROVED: 41, NO Arrived: Departed: Building Inspector 1-4)2._-,2A0A-C2-- '?.-- C) ...-- BYE ` .,b e.‘,, , /46 e_, eo C 06 k z -„,--, ,,, cN . . .8 , . . c, f I cool 3 > Lli Ler lc A-0313 g ti \id\ , 0O / "I have seen or observed,or believe I saw evidence of, all objects such as houses,wells,trees,fences,etc., shown on this document I also represent that I have personally measured the distances set forth on the diagram." SIGNAT E DATE