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2002-829 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020829 Application Number: A20020829 Tax Map Na 523400-3,08-009-0001-0251-000-0000 Permission is hereby granted to: For property located at." 657 LUZERNE 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: GYLE CLEMENTS Septic Alteration Residential' 657 LUZERNE Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency BILL THREW INC. 793-3791 NY 12904-0000 Plans&Specifications 2002-829 Residential septic alteration per plot plan and specifications. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, October 02,2003 (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 Tow eensb sda October 02,2002 SIGNED BY _ 4for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal Systom -F'a It ( E Du Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: 0 C T 0 i 2002 _...................... ................................_.........._. ........_.........................._..... Location of installation.: � S� � �c Z e r Vx f Voq Tax Map No. 1 / File Permit No. Q Owner's Name: Fee Paid G' f e Yin Gpp vtvlfS ..... Address: G '�� Z-.� -z�r��cv ............ .......... ............................ ......._.._.__..........._.._............... _..m.__......_..... 2. INS'TALLER°S NAME i3 t t `T I1y c�� ✓t)c 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 BedoMS x Computation = Tgtal�Daily Flow 1980 or older x 150 gal/bdrm = 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) T - Soil Nature GroundWater Bedrockor Impervious Material Domestic Water Supply t at what depth at what depth municipal Rolling . ' o feet LOD feet I <�rveT Steep slope clay if well;water supply '.(9 %slope other. from any septic system depth: 3t> absorption is /-�-a ft tither Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construr.9 n: All individual sewage disposal systems must be designed by a licensed professional engineer or architect sunless installed in a Planning Board approved subdivision). Add 250 gallons to the size of the septic tank and leach field for egtrh Garbage Grinder,Spa or Whirlpool Tub. Septic Tank: gallon (min. size 1,006 gal; Tile Field: each trench fl Total System Length: ft, Seepage Pits}; number of ��'- size ofeach: g fi by f3 Size of Stone to be used: # t 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 ofthe Code of the Town of Queensbury,any permit or approval granted which is based upon or is granted in reliance upon any maternal 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. Signature of respon-412jd person - Date 'I.MVII of t�tt�c�n;t2ns i-_Y s(twCrs stTT(t sewalte. Disposal C:IrsTiTit•: A l))mliti7 X • t RI:I'/11LATI(, N ItI�tZi.?1 IZI,t1]I�:N'1`4 Day F�ONA lnlE!.T t_ to ti�►trt rt- ^^--^^''``�� �"� .,� r:T fc'.a.t }busE G QS 3t'X' llov-sr- G� e � �..• r � SGt'ttG riYx�'ttcsT{ 7. SIGNATURE &INFORMATION POP, V.J � 07 0 �v a .4 H © 0 0 0 11 z0 � H a 0 a Ma ct to to 0 0 -j 0 (D C a :5 :1 :1 (A W " -1 (D H rh rf rN 3 r .� cr�► .� a(D 0 -h z rD rr G 0 t u� N C m � � 70c 0, x c'+' yip 't1 G rt 0 \ of C� � 0 � OrM X (D 00 (D (D mr ) z rF 0 1 � m ►,( �+ „1 0 lTJ�1i 1 6 p ( 0 r- C 0 N4 � R� M 0 u) � � pp x'C 70 �^ �� 6 r to n m z rD (D (D rt ti zmrom � z -�� OR (WJ ✓ +) IIJ 4� 0 0 O-e p p 0 N r co / I N -P M C vN a '� N CC ro 44 t�, E N 0 C 0 x 0. � r' 11 0 � o tt \ 0 -P •� c �. .,, 0 ro ro 0 1 0 C4J 0 Z4- 0 0a� � �'r0. " Jar p go! L 11I 0 0r WUa0L" ,Y Q ICL v� a : N a. .ahU. 00c � 4J00 4J4J0 yr �Hry " (00 Q) r0S t� ro v1 +N 0 w + 0 v� . �► ro ` a 1tla a W M ij +) 7' 010 0 1- or- M/ V I � F. � �{t b � 1Y 0 wi w O 'rVy 4- 01 N px \ 000 0CY � 1j �w�j u r 0 4- 'r" 0 0 Lng or.q-"1.. 0 L L ►1/ p ` " 1 1 40 a LL 0 aw PdmM 4J4J -P 01 r- ro W �r I � W 14' , cM ro ro ro w � 0� a w u H w 0 M+l 0 A, 0).�; -P C C it .� � C .0 aNw N O"A. V) Q)U :1 :3 acUor 0 *0 gip, ,p 0 t C� 0 �r "J� �'0 0 41 +rLU•r- 4Hr• it"r 0.0 0 0 (3 0Q U (. +r0 V z a i� 0O.JLLLL w��. � U) QA 1 S d S NLT��co �y ti 2� goo, �� Cj - � r u r--� I� a ©� r� t� \5 MO� wtal ,y$ CZ 1VeM OF 1;��I�iri.+URY ku r;K�MLiY i Ned on our limited axamination, o; x compliance with our comments shall Ir not be construed as indicating the .. plans and speciblions are in Ul N compliance with the 4` 1 r*1 TOWN Or Q1 'EMBURY BUILDING& 5 T. REVIEWED BY DATE �� � r✓� Cemc�,�s ya°'qj