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2001-687 TOWN OF QUEENSBURY Fora742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010687 Date Issued: Wednesday, September 12, 2001 This is to certify that work requested to be done as shown by Permit Number P20010687 has been completed. Tax Map Number: 523400-296-009-0001-071-000-0000 Location: 10 MAPLEWOOD Dr Owner: MICHAEL T. VERRA Applicant: MICHAEL T. VERRA This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY ratetPisi - 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: P20010687 Application Number: A20010687 Tax Map No: 523400-296-009-0001-071-000-0000 Permission is hereby granted to: MICHAEL T. VERRA For property located at: 10 MAPLEWOOD Dr 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: MICHAEL T. VERRA Septic Alteration Residential 10 MAPLEWOOD Dr Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency CONDON SEPTIC &DRAIN SERVICE Plans &Specifications 2001-687 SEPTIC ALTERATION AS PER APPLICATION $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, September 12,2002 (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 T n o uee i,,sday, September 12,2001 SIGNED BY , for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Oueensbury NY 12804 (518) 761-8256 1. OWNER INFORMATION: ehisal_fivoodOffice Use Location of installation:�U DaREczi����//I� r. /�File"Pemo. ) , (c 7 Tax Map No. 29( / 001 / SEW ^CC-1 1 SEp 1 2nn d . Owner's Name: RICRAE/ 14Ai' '9 T9V q EO � NDCpBRY Address: ifo gliewoucl - 2. INSTALLER'S NAME GI1JCL A)S -,l /,z'-1-7xlmi..Sex Die PHONE NO. ff'-O r L 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 980 or older x 150 gal/bdrm = ‘dd 1981 - 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes— / no x Spa or Whirlpool Installed yes— / no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) T•.p.' aphv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flat , sand at what depth at whet depth unici 1 al Rolling loam VIA feet ��'° 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 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. r Septic Tank:` 00 gallon (min. size 1,000 gal) se-Ls-ilk, _og/ n3 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: # / depth or thickness feet Bed System Size: x length and/or size Alternative System: len g 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. V .FC--7 r----a/ 1 Signature of responsible person Date ��� ni TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Cn)-(:)-No.A 1) Location /(7 Mqp1tcd DateCTt . Permit # () / 6T, SOIL TYPE:' San -Loam-Clay- Results of Percolation Test- (if applicable) Ra -Mi ute/Inch TYPE OF SYSTEM: ��� ABSORPTION FIELD: Total Lent. Length of each t nch / . Depth of trenche 1 Size of stone u . L/7 - 'c7 ' SEEPAGE PITS: N mb••r- Size - _ x ft. Stone size -_ PIPING: Size Type Bldg. to Tank Tank to Dist. Box A Dist. Box to Fi:,ld/P . u- . Openings Sealed. 11 No . Partia LOCATION/SEPARA'ION` Foundation to T.nk �jCl feet • Foundation to A•sorption —7_ feet . . Separation of P .ts feet Conforms as per Plot Plan Ye No LOCATION OF SYS EM ON PROPER Y: (circle . Front Rear- eft Side - Right Side Middle • t - Middle Rear COMMENTS: • SYSTEM.USE APPROVED: YES NO Arrived: &, Departed: jri, f ' - c:_W//// Building Inspector /" oo rn-7, I p' k , pOQ i/Q' p/ 1 ` ,oS ' 01 �10ail GCS ----- 05 -� Xo�► -1-s' (''3l11 0 5 :z® Co 1 OS 4)43 1" 041) a fl � l� OQ 3 i.-04xi 00 '1 hV.c' o©o/ `t dt r 3019{1 5-9 y1-7 "I have seen or observed, or believe I saw evidence of, �� all objects such as houses, wells, trees, fences, etc., �t��� .shown on this document. I also represent that I have personally measured the distances set forth on the diagram." SIGNA _—.._____ .._9___f__o__--_i___- TU RE DATE / 31d® itliti,', ; �, - �e a3nn3ln3a 1d l o a • , ' oNicnne MR;SNEfl0 -4 NAA01 )0-4-'i A -a/ s//e1 3-4/6 9 A D-q-c) kof 1./02of.4.i � °rt/L b'3 S (2-/O/av� "-7, ' ' °%S 5Iv°O'l) 61 3 A 73 6"1l) 'CU saa