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2000-582 TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development = Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE CIC Number: C20000582 CIC Date: Tuesday, August 08, 2000 Application Number:A20000582 Permit Number: P20000582 This is to certify that work requested to be done as shown by Permit Number P20000582 has been completed. This structure may be used as a Septic Alteration Residential Tax Map Number, 523400-117-000-0009-023-000-0000 Location: 8 HOLDEN Ave Owner: DIANE CARPENTER By Order of Town Board TOWN OF QUEENSBURY (0" Director of Bu n odetaftw% TOWN N OF QUEEWSBSURY (aw 742 Bay Road, Quecnsbury, NY 12804-5902 (518) 761-8201 + Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000582 Application Number: A20000582 Tax Map No: 523400- 1 17-000-0009-023-000-0000 permission is hereby granted to: DIANE CARPENTER Owner of ,property located at: 8 HOLDEN Ave in the Town of Queensbury, to construct or place a Set)tic 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: DIANE CARPENTER 16 COLUMBIA Ave QUEENSBURY, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency I.S . S. SEPTIC 2 LOWER WARREN STREET OUEENSBUR.Y. NY Type of Construction: Septic Alteration Residential Value : $ Plans & Specifications RESIDENTIAL SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS S25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday, August 07, 200 (I f a longer period is required, an application for an extension must be made to the code Enforcement Officer of the Torn of Queensbury before the expiration date.) Dated at the To ensb ; Mond ,, August 07, 2000 SIC INED BY for the Town of Queensbury. Director of Building & de orcement F Application for Permit - Septic Disposal System Town of Queensbury 742 ,Bery Road Queensbury, NY 12804 (518) 761-8256 C'7 1 , OWNER INFORMATION: :XJ Location of installation: , '1- . (Mice Use File Permit Tax Map No. / / # Owner's Name: `^ Fee Paid 0 _ ` Address: 2. INSTALLER'S NAME : _ PHONE NO, 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply # of bedrooms with applicable gallons per bedroom to equal total dailyflvw) Year of House: No. of Bedrootps x computation - Total Daily Flow 1980 or older x 150 gal/bdrm .-- 1980 - 1991 x I30 gallbdrm = VE 1991 - present x 110 gaVWrm Garbage Grinder Installed yes t"r I no 7 4 Spa or Whirlpool Installed yes I no t :. 4. PARCEL INFORMATION: (circle applicable information St indicate measurements) + — *nit bi tur-0 GrourldLAa&y Bedujpjs sir Impervious Material 6©mQstic Water�upplx 147 son .' at depth at wlout depth mu"topal Rolling aarn feet feet well Steep slope clay if well; water supply slope other from any septic-system depth: absorption is Jt. other Percolation est: (To be completed by licensed professional engineer or architect) Rate: 0e minute per inch 5. PROPOSED SYSTEM: For Nor Construction, All individual sewage disposal systems must be designed by a licensed proressional engineer or architect (unless inslailed in a Planning Board approved subdivision.), Add 250 gallons la she size of the septic lank and leach ficid for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: ,gallon (min. size ], 000 gal) t -- Tile Field: each trench —fT. Total ystem Length: - i+• Seepage Pit(s): number of size of each: ,f?. by fl. 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 1 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 Queensbuty, any permit or approval granted which is based upon or is granted ill 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. lgnature of er nsible person Date TOXIN OF COP BUILDING & CODE T 72� Bay Road Queensbury Ny ]n(g (519) 761-8256 SEPTIC DISPOSAL SYSTEM! INSPECTION Name Location Date Permit # i�oocs - SOIL TYPE• jd- am-C7ay- Results of OF S Percolation Test. TYPE OF ( if a Rate-Minutefinch �� ABSOiiPTION IELD: Total Length Length of a ch trench Depth of t nches =��4 ^� Size of sto SEEPAGE PITS umb r- Size - ft . Stone STZ _____, ft . PIPING: Bldg . to Tank Size jpe Tank to Dist , tf -- -- - r i Dist . Box to Fi x Openings Sealedi LOCATION/SEPARAT es a t a Foundation to Tan Foundation to Abso tion � feet Separation of Pits feet . Conforms as per Pl_o Plan LOCATION OF SYSTEM PRO e ( circle one ) Front - Rear eft s ' Middle Front ht Side COW"TS: SYSTEM USE APPROVED: C _S Arrived: Depa BUJ ding n Pe o ' t TOWN OF QUEENSBURY have seen or observed, or believe i saw evidence of, = ob ects such as houses, wells, trees, fences, etc.. BUILDING & DEPT. :.v.r;= on this document. I also represent that I have REVIEWED BY Ay measured the distances set forth on the di , �. YATE " / " t 40 - - ew% EIVED JUL 1 s 2000 I L 1"fS +EOvDr N � t l a Nr: W' '?"ANK I TOWN OF QUEENSBURY BUILDING &,- CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name r:D ,-- Loca Lion Date -- '- -�L rm i t SOIL TYPE: Sand- Loam- Clay- Results of Percolation Test- ( if applicable ) Rate-Minu /Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total a gth Length of each trench Depth of trenches Size of stone SEEPAGE PITS : UM e Size - ft , x fte Stone size PIPiK6 �. Size ype Bldg , to`Taak Tank to Dist . Box Dist . Box to Fiel /Pit Openings Sealed ? Yes No Partaa LOCATIOII/SEPARAT ONS : Foundation to T k feet Foundation to A sorption feet Separation of its feet Conforms as p Plot Plan -"�`il es No LOCATION OF S STEM ON PROPERTY : ( circle one ) Front - Rear - Left Side - Right Side Middle Fron - Middle Rear COMMEIIiTS: 144 SYSTEM USE APPROVED: YES Arrived : Z % Departed : Building Inspector