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2000-339 will R Cer"tifiCate of Com" I lance Town of Queensky Warren County,New York Date May 17, 2000 @ T4 200@339 i This to certr,ty t at work requested to be done as shown by Permit No. has been completed, This structure maybe used as a�. SEPTIC ALTERATION Location 9 MOORWOOD DR Owner_ �°fl PIRG �9— iy TAX NAP NO. 7 6 A _2-6 By Order Town.Board Q OF FE Director of Building&Code"Enforeement BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury,NY 12804 County of Warren (518) 761-8256 VALUE $ 0 Building Permit No. 2000339 TAX MAP NO. 76 . -2-6 Permission is hereby granted to MOORE, GARY & CAROLYN 9 MOORWOOD DR. Owner of property located at in the Town of Queensbury,to construct or place a SEPTIC 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 Building Codes and the Queensbury Zoning Ordinance. O9 ng( dft,&D DR. QUEENSBURY, NY 12804 Contractor or Builder's Name: -CONDON' S SEPTIC & DRAIN Contractor or Builder's Address: 0 Electrical Inspection Agency: Type of Construction: SEPTIC Plans and Specifications: SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS Proposed Use: SEPTIC ALTERATION 25 May 17 20-02 . $ PERMIT FEE PAID—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.) 17 May 2000 Dated at the To,� --%Queensbury this Day of SIGNED BY for the Town of Queensbury Code-f�dbr&ernent Officer Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: ............................ Office Use Location of installation:920 xuJ 00� Tax Map No. MAY 1 6 2000 File Permit No. �2-3 3 Owner's Name: Fee Paid Ei SBURY ................. ............... ....................................... BUILDING AND CODE Address: A-Lt.1t (3 > r 2. INSTALLER'S NAMJ3(&b&1 a PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 4 bedroom(s)and multiply# of bedrooms with applicable gallons per bedroom to equal total dailyflow) Year of House: No. of Bedrooms, x Computation Total Daily Flow 1980 or older x 150 gal/bdrm 1980- 1991 x 130 gal/bdrm 1991 -.present x 110gaVbdrm Garbage Grinder Installed yes no Spa or Whirlpool Installed yes no ->I 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water supply 4=51 <an at iyhat depth at Wh at• ,depth munici al Rolling loam IV A' feet �9� feet <nwi. Steep slope clayr - 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. Septic Tank: 09 11on (min..size 1,000 gal.) ga Tile Field: each trench Total System Length: �100 ft Seepage Pit(s): number of size ofeach: ft. by-ft. Size of Stone to be used: # 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,pleasenote 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 TOOkM OF QUIEENSBURY BUILDING & CODE ENFORCEMENT 742 Ba,y Road Que�r�sb�r-y NY MZB04 (S 18) '761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location Da -toj� A-0 Pe rani t # ��� SOIL TYPE: Sand Loam- CZ ay- Resul -ts of Perco7 ati on Test- ( -i f applicable ) Rate--M ' Inch TYPE OF SYSTEM= r ABSORPTI OBI FIELD To al Long Length of each trr nc Depth of trenches 3 Size of stone },�� tc_ t2 �► �S SEEPAGE PITS : N umb e :^ Size - -Ft _ x ft _ Stone size A= PIPING : Site Type BZ dg _ to Tank Tanis to D i s t _ Box Dist _ Box to Field/Pi a2 Openings Sealed ? s No Part-i a7 LOCATI f /SEPARATI OHS : Founda *ti on -to Tank. -Feet Foundation 1 o Ab sorp ion feet S e pp a r-'a t i o n o-ti= P i .t s feet Conforms as per P1 o PZ an Ye No LOCATION OF SYSTEM PROPER-Fr ( c -i rcl e e . Front - ear - Left Side - R-i ght Side Middle t=ron -- Mi-ddle Rear COMMiEN-TS SYSTEM! USE APPROVED= YES NO A zr-rr1-w t--cf = / D ep a rted 8u�3 �d -� ng I nsp+ec-Cor r ro +� 4J4J0 a) I d 4J W C 4- >. W d' I `� 0) N � CO 1 0 � QOl ,so .rr p. >" Mo �pq 4J ro � c CC I 44 V) W 0 ,r. r- ,�. ro � tU aJ opt W " r I 0 } '"�`' '' 4J Z v) a) \ y N v ro P +J C j,;oOO ` o� -P J Q his E t © , 00r H r C W u LL u m �• I I Lp LU a ro a? W w~ u C a) �� r-+ 4; Q Q 4• ON) �, 'd H GL A� W ro Qa C�? C 0 ro L 4J 0 , 5. .� Ira loossa� I M a) s. 0 ro 0 4J 0 W in {� 41 C7 W t � � M a) f- 'r, OOCCCro000Q W CG C , 0 02- N AX \ 000 OYS. N al V � F ' Vl W Q lost 0 L. �. ; r 0 IN W' 4J ra) ZQ r W. H � . � w � Q � w z w00)+) o).� pcIcccZ4. < c w > � Eu 41 N4-LV) CaNWN0: 0C0NUz � QCU 'r0 -Oo ,p. m Q (0 © a)or->" M a) ()or- W -t- 4-)M U. I+ a V) � q (qp�j It/VC)KC COA)ot/uy go A Glew rds I .r 35 a m RECEIVED U} MAY 16 2000 F TOWN OF QUEENSSURV B a "I have seen or observed,or believe I yaw evidence u�, j ` J o d� all objects such as houses,wells,trees,fences,etch �, } '� l t that I have � Qr � ,�c��,� shown on this document,l also represent (� �� personally moasured the distances set forth on the diagram.' 0 Ui SIGNATURE F- —j fif ,t o V g6o A Q)d D