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2000-152 s' C', Omp C'erti lCo"' a e o 4 Town of,Queensbur ' Warren County,New York II April 25, 2000 .Date I' 200@152 This is to certify that work requested d to be done as shown bY1'!1ormit No. has been completed, �4 1+ SEPTIC ALTERATION This structure may be used as a 616 SHERM AVE, Location ... Owner CENTERAAR, ERNEST C, k� II TAX M NO. 12 e '- _5® BY Order Town Board I OF QUEEN BURS' I� Q 'T" 1 Director of Building& Code.enforcement ` 11 BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queen"9bury,NY 12804 County of Warren (518) 761-9256 VALUE. Building Permit No. 2000152 TAX MAP NO,. 121 . -4-5 . 1 Permission is hereby granted to CENTERBAR, ERNEST G. Owner of property located at 616 SHERMAN AVE. in the Town of Queensbury,to construct or place a SPPTTC -ALTERATION at the above location in accordance to application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Budding Codes and the Queensbury Zoning Ordinance. Owner's Address: (DOREEN) 616 SHERMAN AVE QUEENSBURY, NY . 12804 Contractor or Builder's Name: Contractor or Builder's Address: Electrical Inspection Agency: Type of Construction: SEPTIC, .-- Plans and Specifications: SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS Proposed Use: SEPTIC ALTERATION $ 2 5pERMT FEE PAID April 13 ' 20�02 -THIS PERMIT EXPIRES (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 of Queensbury this 13 Day:of April 2000 SIGNED BY T�IRW-V�� for the Town of Queensbury 6E Enforcement Officer Application for Perinit—Septic Disposal System Town of Queeiisbwy 742 Bay 1?(?ad Queensbury, Nil 12804 (518) 761-8256 1. OWNER INFORMATION: ............................... .......................... ........................ Office Use Location of installation: hg�e- I Tax Map No. /S/ File Parinit No. Owner's Name: 'Pero--A�cl Fee Paid --L Address: 2. INSTALLER'S NAME : PHONE NO. 3. - RESIDENCE INFORMATION: (circle year of dwelling, indicate ft bedroom(y)and multiply It of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: I No. of Bedrooms x Computation = Total Daily Flow 1980 or older -2- x ' 150 gal/bdrin = web 1980- 1991 x 130 gal/bdrin RF-CENED 991 -present x 110 gal/bdrin = APR 0 3 200a Garbage Grinder Installed yes_ 1 no V J­ 119Y Spa or Whirlpool Installed yes_ no je7 4. PARCEL INFORMATION: (circle applicable information &indicate' measurements) Na�ure Ground Water m . Bedrock or Ina Material Doinestiz Water Supply !"n at what depth at wha depth m X6­ cam oiling feet Steep slope feet clay if well; water supply slope other front any septic-system depth: k1llo- absorption is other Percolation Test: (To be completed by licensed professional engineer or architect ) Rate: 1-2- minute peer inch 5. PROPOSED SYSTEM: For..NcwConstnaction: All individual sewage disposal systems must be designed bya licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size of(lie septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: leev gallon(min. size 1,000gal) Tile Field: each trench Z- ft. Total System Length: Seepage Pit(s): number of size ofeach: ft. by 'Size of Stono to be used: ff "I I or thickness feet o I Bed System Size: V Alternative System: length andlor size 6. HOLDING TANK SYSTEM: (ifrequ* d) Number of tanks: 4aI t: gallons I 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. Signature of responsible person Date ctl 4J -P4J 0 N W � � w c 4- ^^'' 0) x . ' C41' 4 0 or �Mww >,U'1 �{. '0 iY U r /r, or- CrQ r v) ro x 0 � ti �. V� C S W z w z U LL 0 Q� 1 I Ig fro Nr-wWUc0 r 004. av) LL "� rove . 0� p a U) Vq) w cnw � c ° ' ro 4}. U r'�" 4-) �W QJ f� �r V) V) 0 C f C C Q t} w c OrV)W ' Off. N A X %-. 0 �0 0 oLY L W Z W ,0 ) O.IL 04-W N 4J 0M Cnl � .P � Ec � �� �' Q.C� 0 43 �. 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Q � /� O C` z '0 0 0 (D 0 0 0"0 '"�« a '�}*�c+ -is 1`1-As(D M W o4 ,"'I« (D 0 a 0 0.0r, (1 :510CC0roV) :30. ''90NMN"O :5 (Ab -h0 m c+ n � M 2 rD a 0 a H z r+ a a)0 :r soeu c+ It ! e � ro c+ c+ rr co 0 0 " U.4 M-fi 0 � 11V 0 0(A `S jI 0 is J. isIto 0 0 0 1-10 � 0 M I Wa �1 : I � LA 'I X0 0 0 Q S k a N TU) Q-(A 0 M t7 0 m 0 ID 0 Q a > > Z.(A (A r- -4 (D M ci-r .4 n '' M ss� :30) T10 MMc+ 0a 0 � (D 11a � e aC) 'GV i 1 •< ro -1 M cr, -0 (A 01 ro 1 � 0 7 M 3 ro "f :3 ' N ,. 0 N oil � > J > 17 6Q sop I ,I - C50 3 r- � -is 0" 0) -q a (D 0 z (D ct 0 p �► C ' M 0. -h -4 0 0 770 0. ' c (� a s 0 � q 10 r~ a a M 0 z z 6 � .r r a e:3 ` r- ro 1< M 0 Xe e n) x r. sholl 0 N W M 3' '« •< `1 0 ' n fl z_ro:ror ro; (D u fD 0 c+ rF 0 W -IFOWN OF QUEENSBURY BUILDING --& CODE ENFORCEMEN-r 742 Ba_y Ruiaod Que_oensbu1r_V MY X2S64 SEPTIC DISPOSAL SYSTEM INSPECTION Name uoca-ti on ZZ Data P(-_ r-m-1 -t # X c5"00—' SOUL -TYPE : S and- Loam-Cl ay- Rosul is of Pe-r-colation -Test- ( i -F applicable ) Rat inute/Inch -TYPE OF SYSTEM: ABSORPTION FIELD : T tal 'eng-th Length of" each 'tr-anc Depth o-f trenches Size of stone SEEPAGE PI-rS : um5e . - Size - f:, . ft.- Stone size PIPING= Size Type Bldg - to Tank Tank to Dist. - Box Dist - Box to Field/Pi' t Openings Sealed? y S No - P-ar-t-fal- UOCAYI CW4ZSEPARA-TX OHS : Founda-tion to -rank , feet Foundati on tto 'Absorpt cm Separation of -. Pi t-s IC feet Con-Forms as per Plot P , an Yes No VOCA-rICM OF - SYS-rEN ON PROPERTY: 0- ir-cle on-- ) Frant - Rear - Le-Ft Side - Right Side Middle Front - M i d d Rear COMMENTS erow �f � � SYS-I-EM - USE APPROVED -- YES No Airy-1va-d= BuI71~ailing "I have seen or observed, or believed saw evidence of, all objects.such as houses, wells, 3 trees;fences,etc., • `shown on this document 1 also represent that! have Der sonally measured the distances set-kdh on the diagram." SIGNATURE- DATE ' EVE D A rl :'0 3 2000 BUILDumv W I �'� I&OD GAS' f