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2000-455 Certificate of Compliance Town of Queensbury Warren County, Now York .7une 2 8 {} u 0 Date t -- 2000455 � a This is to cerh tat w k re st ii tca be clone a shc� w2c by Permit No. has been completed. SEPTIC ALTERATION This structure may be used as a ___-- 5 TWICWOOD LANE Location Owner TAX MAP NO , 6 8 . - 4 - 10 . 3 By Order Town Board TOWN OF QVFE Director of Building & Cade Enforcement BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury, NY 12804 County of Warren (518) 7614256 - Building Permit No. G.'6_5 Permission is hereby granted to G7y ' Owner of property Located at 15 f'WICOWM).S -- in the Town. of Qw=nsbury, to construct or place a Cv z+at the above Location in accordance to application together with plot plans and other information hereto Mod and approved and in compliance with the NYS Uniform Building Codes and the Queensbuty Zoning Ordinance. Owner's Addre ke. d -NV -[fit" ConUuctor or B r"s Name: t C Contractor or Builder's Lbuyu.�. Electrical Inspection Agency- Type of Construction: rrtc Proposed Use: To S PERMIT FEE PAID — THIS PERMIT EXPIRES (If a longer period is required, an application for an extension must be made to the Code Enforcen emt. Offtaer of the Town of Quee fore the expiration date.) Dated at the T Queens s Day of t �►t SIGNED BY for the Town of Queensbury ode Enforcement Officer Application for Permit - Septic Disposal Syste+n Town Of Queenshuty T42 Bcry Road Queenshury, Ny 12804 (518} 7bl-82Sd I . OWNER INFORMATION: Location of installation: .............................._.,.,........_............ / ........... .......... ._,.., frice Use ic Tax Map No. ! / 3 File Permit No. Owner's Name: Fee Paid Address: ...........-_........._ ..............._...._i 2. 1NSTALLER'S NAMEr;_..� r� PHONE NO. 22,t --�'7 3. RESIDENCE INFORMATION; l (circle year of dwelling, indicate ff bedroom(s) and multiply # of bedrooms with applicable gallons per bedroom to equal total daily flow) Y r of Ho s N roo s x I3ed Co utation — L> 7' l Dail Flow 1980 or older I980 — I99I x 150 gat/bdrrrt = C P ' x 130 galfbclrrn = "—1991 — present x 110 gai/bdrm = J U N 2 6 2000 Garbage Grinder Installed yes ! no Spa or Whirlpool Installed Yes no 4. PARCEL INFORMATION: (circle applicable information & ,indicate measurements) ON Na u r and Wat r Bedrock or I 1=at sand at w a e th rvio s Material om t a er Su 1 aping loam p at whir depth municipal Steep slope clayfeet feet w ,,�5'o slope other if well, water .supply depth: from any Septic-system absorption is ft. Percc+Iation Test; (7'o be completed by licensed professional engineer or other Rate; _ _ _ minute per Inch architect} 5. PROPOSED SYSTEM: Far Mew anstnS &" q: Ail individual sewage disposal systems must be desi ed Professional engineer or architect (unless installed in a Planning Board a � by a licensed of'be septic tank and leach field for each Garbage Grinder, Spa pproved subdivision). Add 2S0 gallons to the size pa or Whirlpool Tub. Septic Tank: 142aQ� gallon rmin. size 1, 000 gal.,} [Yk, f 4 ` 'it Tile Field: each trench -- ft Total System Length: D f? f Seepage Pit(s): number of size of each: .ft by ft. Size of Stone to be used: iI " i / depth or thickness �.�V .,feet � .�`• tr r"`f"c-e !a Bed System Size: x AXecoative 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 a electrical inspection agency. pproved 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 � aC:� mU gnature of responsible person Data TOWN OF QUEENSBURY BUILDING A CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name ace ye " Location Date Z G`l� Permit # Lj 'S 5 SOIL TYPE : SaPT1 y- Resul is of Peest- ( if applicablute/ Inch TYPE OF SYSTE ABSORPTION FILength Length of -ea+eDepth of tren Size of stone SEEPAGE PITS : umber- Size - fto x ft , Stone size _ PIPING : Size Type Bldg . to Tank Tank to Dist . Box Dist . Box to ield/Pit Openings Sear d ? Yes No Partia LOCATION/SEPA TIONS : Foundation to ank feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY : ( circle one ) Front - Rear - Left Side - Right Side Middle Front _ Middle Rear COMMENTS : SYSTEM USE APPROVED : YES NO Arrived : Departed: Building Inspector or-- """ TOWN OF QU€ENSB RY BUIWING & CODE ENFORCEMENT 742 Bay Road Queensbury _NY 12804 (518) 761-8256 v " SEPTIC DISPOSAL SYSTEM INSPECTION Name NS X eCZ Location - Date 1� Permit # cDJXQ Lf5S SOIL TYPE: an Qam-Clay- Results of Percol ati o TeS�t- ( if applicable ) Rate- inutle/ Inc h TYPE OF SYSTEM: Coe— Depth ABSORPTPTON I FIELD : To al Le Length of each trenc of trenches / . . - Size of stone r G 1 SEEPAGE PI F5 : Mumbe - Size - ft . x ft . Stone size PIPING : ran �ype �- Bl dg . to Tank r f�v VQ4#V Taftk"to Dist . Box Dist . Box to Field/P Openings Sealed? artsa LOCATION/SEPARATIONS Foundation to Tankfeet Foundation to A�asorp _ feet Separation of Pitsfeet Conforms as per Plotes No LOCATION OF SYSTEM O( CirC1e �Front - ReLeft Side Middle Front Middl COMMENTS : _ 0 � SYSTEM USE APPROVED : YES N Arrlved�Departed: d: Building Inspector j COMMONWEALTH ELECTRICAL IPiSPECTI{'1N SERVICE, INC Main 0frice 176 Doe Run Road - Manheim, PA 17545 r MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL LA Panel Board No. .. ..........................Cert. Np 2 67699 Cut-in Card No. ...............I........I........... I,� ,2 Owner...... ....... Gl :�. '� . .. ..............................,................ ,...... e; TZU c.. '' . tv G'.:-0'. . '..................... ..................... ........ .. ....,... Location ......,............ .. . S d6FLV c:: . )42_e --�.t r'' �- / ......5................. Installation Consisting of ................ ....... .. .............�......................-........._............ _...,,,. J%'G 7G1+ ?..r.._........, . . ..................... ............. .............................�................e..^.............-, » ,,............ ....,,,......,..._............................._. . . ,,,.............._.... installed By....!!:."�..`..,.�?.. `.[ fl /7J� Lie. Nca. .................................................. The conditions following governed the issuance of this certificate, and any certificate previously issued is 'i cancelled: - ! This certificate only covers the electrical equipment and installation conditions as of date. Upon the introduction of additional equipment or alterations, application shall be promptly made for inspection, inspectors of this Company shall have the privilege of ma kin spections at any time. and if its rules are violated. the Company shall have the right to ke is fecal e � O " iGI , .. INSPECT _.. �- i' .......................... Date.............. . ..............-................. •„�.� Member N.f-P A., l_A E.l. lot "i have seen or observed, or believe I am , all objects such as houses, wells, treed kxK gJ4 shown on this document. I also ►epreseet tM I have � person measured the distances set fiorlb on the DATES v . , n Artier:' LL r- m 010� D L m .R t' c � 70 w w OV c LLI z 8CO2 COY , � A Ma � icM io via CO J mm 1 C �t� �� �cJ W (OW) w C) t t° 't;'r !YI40V �f QC/4 a ttJ 1We lNlQ�flLN