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2000-906 TOWN OF OUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 76W256 CERTIFICATE OF COMPLIANCE Permit Number: P20000906 Date Issued: Tuesday, November 28, 2000 This is to certify that work requested to be done as shown by Permit Number P20000906 has been completed. Tax Map Number: 523400- 68-000-0002-005-000-0000 Location: 29 TWICWOOD Ln Owner. {o DEREK & ELLEN RICHARDSON Applicant: This structure may be occupied as a; By Order of Town Board Septic Alteration. Residential TOWN OF QUEENSBd1RY Director of Building & Code Enforcement J EENSBURY TOWN OF OUEENSBURY ry 1 804 5902 (518) 7b1-82L?1 BUILDING. & CODE ENFORCEMENT , 742 Bay Road Queensbury NY 22804 (sia) Esc-sash Gent - Building 8Z Codes (518) 7614256 SEPTIC DISPOSAL SYSTEM /INSPECTTQN G PER.MIT Fame 4�K. ..... Loran on ,` Application Number: A20000906 Datt i ;ewe Permit # - .� ' 000-0000 Spit E Sand- oam-Clay- r RICHARDSON Results o ercol ati on Te t- 0 Lts ( if applicable ) Rate� Min to/ Inch TYPE OF SYSTEM: ' ABSORPTION FIELD : Total L .ngth 25 gether with plot plans and other information hereto filed Length of each trench / an Building Codes and the QueemburyZoning $ 7Zi.' of stone Depth of trenches �l Type of Cgristructim Value ' SEEPAGE PITS : um er ?N - Septic Alteration Residential Size ,f,,� . X �,t . Stone size— Total valve PIPING: - ze ype Bldg , to Tank ys� Tank to Dist . Box y Dist . Box to Field/ i rr Openings Sealed ? e o Partial Electrical Inspection Agency LOCATION/SEPARATI Foundation to Tank -*' feet Foundation to Abso ti on feet Separation of PitE7 s feet Conforms s per Pl t Pl an No LOCATION SYSTE ON PROPER ( circle one Front - Rea - Le t Side - Right Side Middle Front _ Mi die Rear COMMENTS: SYSTEM USE APPROVED : YES NO E�'M� EXPIILES: Thursday, November 28, 2002 xtensian must be made to the code Enforcement Arrived : Departed : - vember 28, 2000 " .,:ch for the Town of Queensbury- Building Ins ector orcement Application for Permit — Septic Disposal System Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1 . OWNER INFORMATION: K f L +�} cKrip a Use Location of installation: 1 C_- 0 p 1) f File Permit No, 42 Tax Map No. Owner's Name: �� i ch ,14✓ al s7 Fee Paid Address: p%� / 1 2. INSTALLER'S NAME : YH04L gq 2! 3 . RESIDENCE INFORMATION: (circle year of dwelling, indicate it bedroo O�`v # of bedrooms with applicable ,gallons per bedroom to equ E' Y pr_ofHouse: No. of Bedrooms x Computation Total Daily Flaw 1980 or older `]� x 150 gaUbdrm = t!!© 1980 - 1991 x 130 gallbdrm = 1991 — present x l 10 gallbdrm = Garbage Grinder Installed yes , / no Spa or Whirlpool Installed yes f no 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) T.oaQgraphy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply CI sand at what depth at what depth untci ollin,g am feet feet well Sleep slope clay if well; water supply T% slope other from any septic-system depth: absorption is fi. 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 TankA ,gallon (min- size I, 000 gal.) / } Tile Field: each trench _ k `?ft. Total System Length: Seepage Pit(s): number of 1-A0 size ofeach: ft. by _ f1- Size of Stone to be used: # - 1 A -_ t depth or thickness feet Bed System Size: x Alternative System: length andlor size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: I Size of each: gallons f 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 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 rea regulations with res eat to this application and agree to abide by these and all requir ants o e Town of Qu ensbu Sanitary Scwage Disposal Ordinance. ltl)A slglqaRt7ure of rasp ble person ate 4 f Lu CD J) 0 •� w Q I. `` Q "1 have seen or observed or .A o C3 believe 1 saw evidence of all objects such as huusR . ' shown S, wells, treP,S, fences Ptc., O as on this dccmm �t. I ai C Person n sa ropte%.'fit tf,�+ I have Y �a"Ied the distance f 3 s S t ,�rcr3 on the diagram," SIGNATURE I DATE qq � r� 1 ih i 1J* �J 1 t � ��� i TOWN OF QUE N RY �% 0/1 BUILDING &� T. , ; REVIEWED BY ca, DATE C`' � I i 1