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2002-705 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 OF CERTIFI ATE COMPLIANCE C Permit Number: P20020705 Date Issued: Wednesday, August 21, 2002 This is to certify that work requested to be done as shown by Permit Number P20020705 has been completed. Tax Map Number: 523400-308-014-0001-039-000-0000 Location: 29 AMETHYST Dr Owner: JOHN &NANCY DUFF JR r n n �:.- Applicant: JOHN &NANCY DUFF JR This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY \ Director of Building&Code Enforcement TOWN OF QUEENSBURY 11%). 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020705 Application Number: A20020705 Tax Map No: 523400-308-014-0001-039-000-0000 Permission is hereby granted to: JOHN&NANCY DUFF JR For property located at: 29 AMETHYST Dr in the Town of Queensbury,to construct or place 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. Type of Construction Value Owner Address: JOHN&NANCY DUFF JR 29 AMETHYST Dr Septic Alteration Residential QUEENSBURY,NY 12804-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency IBS SEPTIC IVAN BELL 2 LOWER WARREN STREET OUEENSBURY,NEW YORK Plans&Specifications 2002-705 Residential septic alteration as per plot plan and specifications. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 20, 2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Offi rer'77 rr of the Town of Queensbury before the expiration date.) Dated at the Tow. !ueensb ; 1 e „ ugust 20,2002 SIGNED BY C for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System ,) Town of Queensbury 742 Bay Road Queensbury,y,NY 12804 (518) 761-8256 1. OWNER INFORMATION: AK. ` 2002 Location of installation: j4 (p. 4(45 uvv B ,10121;77)5V :- File Permit No. Tax Map No. / / Owner's Name: / iU Fee Paid 7 Y 00 ,�J �j '�"" v .l�— Address: -25 ` l � (Lir dd ° i ` St Q' ,Sb 1 /f ' 2. INSTALLER'S NAME : . /L , • Srvi l PHONE NO. 721 yj 27 3. RESIDENCE INFORMATION; (circle year of dwelling, indicate 11 bedroom(%) and multiply II 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 older x 150 gal/bdrtu = 1980— 1991 3 x 130 gal/bdrm = 9 ca 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes, / no Spa or Whirlpool Installed yes / no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) T 'aplt • a tire Ground Water Bedrock or Impervious Material nest-i Wa r Su way 1'a- sand at ti h r!depth ai w1 cr eptlr municipal lll!/rg awn A-feet feet ell Steep slope clay if well; water supply %slope other froth any septic-.system • depth: absorption is ft. 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 lank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. 6 kIP-7P c Septic Tank: /490,gallon (min. size 1,000 gal) Tile Field: each trench 5 C.) .11. Total System Length: ?0 0 f t. Seepage Pit(s): number of size of each: ft. by fl. • Size of Stone to be used: it 6 / depth or thickness 1 _feet Bed System Size: • x Alternative 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 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 road the regulations with respect to this application and agree to abide by these and all requirements of the Town of ueensbury Sanitary Sewage Disposal Ordinance. r Imo'' j ;p ure of resp onside arson Date j4 TOWN OF QUEENSBURY BUILDING A CODE ENFORCEMENT 742 Bay Road Queens bury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 'a_ 2,#- Locati on -25 ir..egs� c)1 Date V2-/Q---- Permit # Zo071-1t � SOIL TYPE �"an oam-Clay- 01 Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length . -1_, 0 Length of each trench 4 (7. �1 Depth of trenches �iR Size of stone . TA--(o2,-' SEEPAGE PITS: Number- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank "T '`.:— Tank to Dist. Box ... ' ' Dist. Box to Field/P' I Openings Sealed? o Partial LOCATION/SEPARATII Foundation to Tank '',-A-feet Foundation to Absorption a, feet Separation of Pits eet Conforms as per Plot Plan __ , o LOCATION OF SYSTEM ROPERT' : (circle one Front Rear eft Si. ight Side Middle idd ear COMMENTS: CC 1-01 ,`I SYSTEM USE APPROVED: E NO Arrive `; '© Depart : I, / . din spector. • a _Li-1.7_6 5— • . • V . t • ; — 177:71--------5 • ) . • , I • ,,,3,,,,sE:u-RD...:- ,:---- .„.;.. _. ,:.:11, — — '— U,:_ e, aa se,uep a paa � �ea s !u A2en esads1 a p s o mobs, I. • , 0 c 1 a 2 e .. .—__.._—_—_._._.—..—. _.t_ ✓ V` t?cd�td i7 J 4. �f� (�rppg'�¢� -(+{�3 y�P �y 4J 1v1 ,3 l.,r •Jk7c}i tE: JG �.pfS $ • `o.2t rta s a#'{-f?Ct � c1 , 1 )0 . , i , . ' , : ��� - . "�' . : : . I - 1. ' �- . ' • I it i . 5`\ s� V • • • I II `� N ; `� � ice� • 0 0 (::.. F ' • - - ad ___ . . �Pt7 � �. 1 � c if .