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2000-633 TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF C +OMPLIA.NCE CIC Number: C20000633 CIC Date: Thursday, August 24, 2000 Application Number: A20000633 Permit Number: P20000633 This is to certify that work requested to be done as shown by Permit Number P20000633 has been completed. This structure may be used as a Septic Alteration Residential Tax Map Number: 523400-090-000-0004- 130-000-0000 Location: 6 HEINRICK Cir Owner: jOHN & PATRICIA IR ON By Order of Town Board TOWN,*O�E ENSBIJ 1tY yLJI\] Director of Building & Code Enforcem nt TOWN OF QUEENSBURY 742 Bay Road., Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number• P20000633 Application Number: A20000633 Tax Map No: 523400-090-000-0004-130-000-0000 Permission is hereby granted to: JOHN & PATRICIA UtION Owner of property located at: 6 HEINRICK Cir 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: JOHN & PATRICIA IRION 6 HEINR_ICK Cir QUEENSBURY, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Type of Construction: Septic Alteration Residential Value : $ Plans & Specifications 2000-633 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAIR - THIS PERMIT EXPIRES: Saturday, August 24, 2002 (If a longer period is required, an application for an extension most be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Hated at the Town pf1QT1rbqnsbu. Thursd y, August 24, 2000 SIGNED BY for the Town of Queensbury. Director of Building & de orcement 1 Application ■ in Pciamil -- Septic Disposal Systelt, 7'011?1) of QNt.It,'!l.sbt1 y 742 Beri) 1?wr[J N1 12804 (.518) 7614f,236 I . OWNER INFORMATION* _:......._.......,.__._._. . ......................_...._..__..._..,._...:.. ...... _..... C'' 1 l � � Location oTinslallatiotl: �� t L ,,� � Office Use rrle I'oltnit Nu. Tex Mail No. I I rr foes Paid 0 0 Clwnar'1A Narita' Anon) Addromod !rJ ^./ c G4/ pr 2. INSTALLER'S NAME : l+rr PI ION E NO. 3. RESIDENCE INI:ORM,A,riON. (circlo jry rr ordwcm,,v,, ffrcliewe Jl beth, ,rrrr(s) ar,d n[ulti )ly if cr/' bech-m trs with nmilicnble gallons per heclrwom 1.0 equal teas! cIllily flcslr} Year aFi Iouso: No. of Bodroas x comp 110.1 iull - Total Ual Flow m 1980 or oltlor x 150 gal/bill III 1980 -- 1991 x 1301,a1/lydrlil = '- UG 2 2000 1991 — preseltt - _ x 11 V gallbdi In Gatbago Grinder Installed yes / no Spa or Wiurlltool lustalled yes I uv At- 4.. PARCEL INFOMMAXIOlN: (circle npirlicatrlo infvranntitrn ZPG IntIlCtltp ellpn5111p1AtCI1tSj ' " play _ 5oil Na I10 QktWIrt l `eVnt4r_- Hgok o_I:k_oi 1-mllclviot►s Mntetial �I�vn Wntci_Stilxl�lY a►fi a►rr cot what mric/rrfr .r! n lcrN dooptIl rrar,rcl self tgrll!►r,K OU111e fc'cf fie 19ZWell sternly afupe Clay if'lvell; lvaaser .supply slope vlher fi oars any septic-sy.rlenr aleplls, absoilmurr is ft. wher Parcalatiott 'I'nst: (l'c7 be c`rrirajrfcleef by licelrred jai•c�i�ssiulrcrl clrglrreer� err rrrclrileClf � _________ Rafe inholrle peia inch 5, PROPOSED SYSTEM. For New Colrsh-tiction: All ilidividual se3v;rgc dislxlsal sy'slenrs innst Esc do cit;netl try :, licensed litoressional englucer or architect (nnlcss installed in ;t lrlantlilli Hit-11t1 ulril[as'a1 5ubdivisiun). Add 250 gallons Its Ille size or llic sclrtic lank and leach field lire c:sch Girl bage Gr 111der, Slit or W llir tix)ol 'hob. rp-Yr f rz•c+ Selktic Tatlk: 1 0 gcrllurr (rrrirr. size I,©av gu1.J 'Pilo Fiold: each worsell I it. Total Systcen Letigilt: � fi. Soepago Pit(s): rrrr►rrber af_-7_� L sixe rtf,ecsCfr: r fl. 1"y �_ /i. Size arStorto tv bo trsptl: 1! ,_,__� _ f cfatlrrfr car !lrlck►►e,rs _�.__.�___.Ii'c'� Bed System Size; x Alternative System: length atIti/vr size G. HOLDING TANK SYSTEM: (if required) Nutnbor of tanks: f SIze of cac11: gallons / TOTAL CnImcity: l;allons Note. Alarm System and associated electrical work must be inspected by a Town opploved electrical illsllee ien agency. 7. SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please react) For your protectiokr. plonse state that Iturst,n+tt to Sectivu 136-7.9 of like Codo of 1110 -I'ow,t of" Q%leensbtrry, ally pellnit or npploval granted which is Leased tslron or is gint,ted i,t leionetco upon ntty rental ink aniClelrlCRpnlntiolI trr 1:tiIllre 1n mako a lttllelinI ract. Ur cilctrrnstanco kuowat try or orl bellalrof till applicnert. shell be void. i llnvo Aontt tllo ragI1l,Iriolls wil11 Icssircet to 111iA nleillienlion nntl nitiva Its. ntritla by Iiresp nett all rcriulronro rthe 't'owit ar Qtiocrrstrtn y Sauital y Sewago Disposal ottlillattce. ligature of rasp"tlslbleerson F Dal TOM Of QUEENSBURY 5 BUILDINGS CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 oS8) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Loca ti on ( &e- r /� ,� r c � '�c -�-' Date Permit # = SOIL TYPE : Sand oam- clay- Results of Percolation Test- ( if applicable ) Rate-Minute/ Inch TYPE OF SYSTEM: ABSORPTION FIE Lq;. Total Length Length of each r loch _ Depth of trends Size of stone SEEPAGE PITS : m er- , Size - I �'-*. r ft x l ft . Stone size ze --� PIPING: Bldg . to Tanis Tanis to Dist . Box Dist . 'Box to Field/Pit � Openings Sealed? Yes o artsa LOCATION/SEPARATIONS : feet Foundation to Tank feet Foundation to Absorption feet Separation of Pits Conforms as per Plot Plan a No dooO L TION OF SYSTEM ON PROPER 7e one ) Fr6ln - Rear - Left Side - Right Si ti Mi dd Front - Middle Rear TS : SYSTEM USE APPROVED : YES NO Arrives#Departedw Building Inspector TOWN OF QUEENS8URY �~ ILDIN6 b CODE ENFORCEMENT 742 Bay Road Queensbury NY I2804 (5is) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION 1 Nam C) CLoc i on ''� - Date ermi t SOIL TYPE: Sand- Loam-Clay- Results of Percolation Test- ( if applicable ) Rate-Minute/ Inch TYPE OF SYSTEM: ASSIDRPTiON FIELD : Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS : 111 umber- f t . Size - 0 ft . x Stone size PIPING: Size" ype Bldg . to Tank �--- Tank to Dist . Box Dist . Box to Field/Pi t Openings Sealed ? Yes____Wa artaa LOCATION/SEPARATIONS : feet Foundation to Tank feet Foundation to Absorption feet Separation of Pits Conforms as per Plot Plan -� ems No LOCATION OF SYSTEM ON PROPERTY: ( circle one ) Front - Rear - Left Side - Right Side Middle Front - Middle Rear - SYSTEM USE APPROVED: YES NO f Arrived: ' Depar ,1 in Insp t "f have seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., -... -_ Chi 4 'fl ., tl7f\ d - c�;lle� I is{' FO�reS�i7t that l have . JI ¢! l , .off�l�u ',3-isf..`i:f i �F�rjC + � P ! � P„4. di��� t ford" on thw � iag.am.'' ! m SlGNAT [DATE z W � D. U. m Z w t- 3 �- V 5 0 C Ci a PyJJLD .. K D Jr i