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2000-489 TOWN OF QUEENSBURY ` 742 Bay Road, Queensbory, NY 12804-5902 (518) 761-8201 Community Development - Building Zia Codes (518) 761-8256 CERTIFICA'TE OF COMPLIANCE C/ C Number: C20000483 C/ C Date: Thursday, July 20, 2000 Application Nurn er: A20000527 ,� J r. Permit Number: P2000 489 This is to certify that work requested to be done as shown by Permit Number P20000489 has been completed. c A5 - 19 �Q This structure may be used as a Septic Alteration Residential Tax Map Number: 523400-082-000-0005-036-000-0000 Location: 19 WHIPPOORWILL Rd Owner: THOMAS &. MAUREEN WORTHING By Order of Town Board TOWN OF QUEENSBUO� Director of Building & Code Enforcernent TOWN OF QUEENSBURY t 742 Bay Road, Queensbury, NY 12804-5902 (518) 761 -8201 Community Development " Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P2OOOO489 Application Number: A20000527 Tax Map No: 523400-082-000-0005-036-000-0000 Permission is hereby granted to: THOMAS & WORTHING Owner of property located at: 19 WHIPPOORWILL Rd in the 'Town of Queensbury, to construct or place a Septic Alteration Residential 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. Owner Address: TH©MAS & WORTHING MAUREEN 19 WHIPPOORWILL Rd QUEENSBURY, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency OUEENSBURY SEWER ]AY SWEET Type of Construction: Septic Alteration Residential Value : $ Plans °& Specifications $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday, July 20, 2002 (Ifa 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 To�Vnof ens , ,..duly 20, 2000 r�t `}Cs� for the Town of Queensbury. SIGNEL:7I3Y �'"� � ry' Director of Building & Code Enforcement Application for Permit — Septic Dispersal System Town of Queensbrtry 742 Bay Road Queensbury, NY 12804 (518) 761-82.56 1 . OWNER INFORMATION: :. .............................................. •........................,,_....................... Office [Jsc , Location of installation: _ ;+L) 1 Tax Map No. File Permit No,1 / _ — Owner's Name: Fee Paid Address: y r 7r 2. INSTALLER'S NAME : - C.C's< t PHONE NOZZ Z�L� ISI� 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 0 bedroom(v) 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 1980 or ol� de '" 1980 -- 1991 x 130 gallbdrm 1991 — present x 110 gaVbdrm = Garbage Grinder Installed yes Spa or Whirlpool Installed yes ! JUL 7 0 ZQQO 4, PARCEL INFORMATION: (circle applicable information & indicate measurements) +; f Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply ' at what depth at what depth rnr+nici �a ng oam feel feet well .Steep slope clay �— if well; water supply %n slope other from any septic-system depth. absorption is ft. ether Percolation Test: (7 o be completetd by licensed prt fissional csngineer rrr architect) --__W Rate: minute per inch 5. PROPOSED SYSTEM: For New Constniction: All individual sewagc disposal systems must be designed by a liccnscd professional engineer or architcd (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: I 4q!z2a gallon (miry. size 1, 000 gal.) Tile Field: each trench _ �4D-..—JI. Total System Length.: � Jl. Seepage Pit(s): number of.._ size of each: fi. by Size of Stone to be used: 11 / depth or thickness Jeer Bed System Size: x Alternative System: �r length and/arsize 6. HOLDING TANK SYSTEM: (if required) Number of tanks: l Size of each: gallons l 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 tho Code of the Town of Quoctisbury, any ,permit or approval granted whicly 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. OC Signature of responsible person Date TOWN OF WEENSSURY BUILDING A CODC CN ORCEMfNT 742 Say Road Queen_ sbury NY 12804 (szs) psi-sz% SEPTIC DISPOSAL SYSTEM INSPECTION Name (VORTgl., & Location l '4 t )JIttep6400E0C4,C, Date '7 l Perai t # SOILri P and- O tl ay- r Res its f Percolation Te t- ( ii appl cable ) Rate-Minut Inch TY E OF YSTEM: AB ORPTI FIELD* Total , n Length o each trench Dep"O of trenches Size, of one LT SEEPAGE P TS : N um a r- I _.._ Size ft . x f Stone size _ PIPING : - iz Type Bldg . to "fan Tank to Dist :,, ox Dist . Box to F Id/Pi Openings Sealed Yes No a� rt aT LOCATION/SEPARAT ON . Foundation to Tan feet Foundation to Abs rption feet Separation of Pits eet Conforms as per PI t P1 an Yes No LOCATION OF SYSTE ON 'PROPER ( Lo cle one ) Ft - hear - L t Side - fight Sid Mle Front - fiddle Rear CNTS , SYSTEM USE APPR()VED : YES No Arrived: -JLA Departed Building Inspector ` I have Seen or W bellen I saw Mmence of, objects such as wdk t, e�Cy shown on this daoNMORt, she r+aprnent that I have pars Wally mealllfM MM teeth on the diagram SIMAnxDATE t �. - N D WN 0 QU . ENSLPRY T. REVIEWED Y - . .rnG1 DATE f]UOZ ? 7n f kizi1