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2001-209 010. ,iffmA TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010209 Date Issued: Monday, October 01, 2001 This is to certify that work requested to be done as shown by Permit Number P20010209 has been completed. Tax Map Number: 523400-289-008-0001-079-000-0000 Location: 962 BAY Rd Owner: RONALD & SHIRLEY HARRIS Applicant: RONALD & SHIRLEY HARRIS This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY rei.4104 vol‘ Director of Building& Code Enforcement el �� TOWN OF QUEENSBURY Fool 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010209 Application Number: A20010209 Tax Map No: 523400-048-000-0003-053-000-0000 Permission is hereby granted to: RONALD & SHIRLEY HARRIS For property located at: 962 BAY Rd 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: RONALD & SHIRLEY HARRIS Septic Alteration Residential 962 BAY Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency OUEENSBURY SEWER JAY SWEET Plans & Specifications 2001-209 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,April 30,2003 (If a 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 Town of Queensbury; Monday,April 30,2001 SIGNED BY 4 i, for the Town of Queensbury. Direc or of Building& g•a e '. orcement v D Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ai")\ � 1. OWNER INFORMATION: ...................... Location of installation: qt a 87 tif_ (Tho Tax Ma No. / File Permit No. ' /- ) P Owner's Name: G fey. 1 d --�— , y 1/1 S--' Fee Pai • �e ►D I Address: q b ,2 Tee Z 1"L_— 2. INSTALLER'S NAME : PHONE NO. RECEI v E( 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of SEP 2001 bedrooms with applicable gallons per bedroom to equal total daily flow)1.0, NOit(�;:�`V"EERY Year of House: No. of Bedrooms x Computation = Total Daily Flow '�'� � � "-! 'CODE 1980 or o ,; x 150 gal/bdrm = i •80— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes— no Spa or Whirlpool Installed yes i / 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Topinohy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply C_Elat sand at what depth at what depth municipal 1-ling oam feet feet el Steep slope clay if well; water supply _%slope other from any septic-system depth: absorption is _ft. other /30 _r— Percolation Test: (To he 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 Tank: /o G1 gallon (min. size 1,000 gal) Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s): number of size of each: _IL by f. Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System:f(C-rt ,!J 5cic� o x_d/orsize / 3 0 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 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. Ee , ?...- 2 d / S'gnatu f responsible person Date 3 = V) TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 `(518)761-8256 1 SEPTIC DISPOSAL SYSTEM INSPECTION Name 11,AKle 1') Location 6767i I ' R.O Date 41 4Z1 Permit # et-LDS SOIL TYPE: and-Loam-Clay- Results of Pecol ati,on Test- (if applicable Rate4,Minute/Inch TYPE OF SYSTEM; ABSORPTI FIELD: Tot 1 Length Length of ch trenc Depth of tr ches Size of stone SEEPAGE PITS: Number- Size - ftt x ft. Stone size PIPING: !! Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field Pit Openings Sealed? Yes No Partia LOCATION/SEPARATION : Foundation to Tank feet Foundation to Absorp ion feet Separation of Pits feet Conforms as per Plot P an Yes No LOCATION OF SYSTEM ON ROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: CGO rice-5 a)���� /& A I /v ✓t)64v s . --' C \� SYSTEM USE APPROVED: YES NO Arrived: ..7_40 -- Are—' Building Inspector Ark TOWN OF QUEENSBURY -BUlL ING & CODE ENFORCEMENT 3 f'"' 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name / C, S Loc it On �Gvt3y' r ) Date q 17 / Permit #01 7-Os SOIL TYPE Sand- oam-Clay- Results of -.- col ti on, Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: T tal 'Length Length of each trenc 1 -3 b Depth of trenches Size of stone e-.t-> >4-/ SEEPAGE PITS: Number-; Size - ,,_ ft. y ft. Stone size 'a PIPING: \, Size Type Bldg. to Tank t ._,J y�' Tank to Dist. Box u v 2 ' Dist. Box to Field/ ,��� s i Openings Sealed? Yes No Partial LOCATION/SEPARATION . / Foundation to Tank _ ,, l feet Foundation to Absorption ' feet Separation of Pits �� eet Conforms as per Plot Pl an r No LOCATION OF SYSTEM ON PROPERTY: one) From am Rear - ide Right Side M ddle Front - Middle Rea' COMMENTS: SYSTEM USE APPROVED: YES NO Arrived: ,11v5r-- Departed: . gip( Building Inspector 704) TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location Date 9 7 4 Permit # Qi '2 i SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) R; Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Tota' Length Length of each tr,nch Depth of trenches Size of stone SEEPAGE PITS: Num• - Size - ft. ft. Stone size PIPING: — Size ype Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pi Openings Sealed? Y:s No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorpti tin _ feet Separation of Pits feet Conforms as per Plot P an Yes No LOCATION OF SYSTEM ON 'ROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: Sot Peise//40% 4,4 SYSTEM USE APPROVED: YES 4 Arrived: ,Oi Departed: Ok" Building Inspector 0 TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location Date Ic- f a60 j Permit # SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-.inute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: To . ,ength Length of each trenc Depth of trenches Size of stone MIS SEEPAGE PITS: Numbe Size - \ft. x ft. Stone size PIPING: Size ype Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pi Openings Sealed? Y:s No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot 'lan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: le1p cr 1'y 4ir Oh CIA//• � /UBW rh/l, raj ,uff'Vht' cap SYSTEM USE APPROVED: YES NO Arrived: /cs.'/I Departed: Building Ins for ' "1 _. ,' 0 ‘i3 .\\ , [ _ 2-- .()q IJ Al ._-7r 'sb j /Q` :J MIA/ ' Gvc- \ \ \,„ o . (---- 44 ':5 • 0 TOWN G BY 1= CUEEJSBURY __._._.__.__ BUILDING & EPT. ": 1. REVIEWED �� Y' ' ��� c i--- OA7E i n 4 VED f-ReY,a�LG'�' 3 C�I SLY j001 0� Q:ittSBDRY TOWS �'n CODE64//liel4r • j)) , (; . 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