2000-496 1� t
TOWN OF QUEENSBURY
0410110114
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
C/C Number: C20000488 C/C Date: Friday, July 21, 2000
Application Number: A20000524.
Permit Number: P20000496
This is to certify mat work requested to be done as shown by Permit Number P20000496
has been completed.
This structure may be used as a Septic Alteration Residential
Tax Map Number: 523400-127-000-0005-008-000-0000
Location: 53 OHIO Ave
Owner: LARRY CLUTE
By Or r of Tc Bard
TO •fr SB r•
Director of Building&Code Enforcement
Oillik-' ' TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community•Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20000496 Application Number: A20000524
Tax Map No: 523400-127-000-0005-008-000-0000
`• Permission is hereby granted to: LARRY CLUTE
' Owner of property located at: 53 OHIO Ave
' 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: LARRY CLUTE
13 DAWN Rd
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
CLUTE, LARRY'a,W.
R.R. #6 BOX 140A DAWN RD.
OUEENSBURY,NY - -
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Type of Construction: Septic Alteration Residential Value : $
Plans &Specifications
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,July 20,2002-
(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,,To*jf Quee sbury<•, Thursd y,�,July 20,2000
SIGNED BY �,. - for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
y ,
Office Use
Location of installation: 3 akar) P\ve
File Permit No (O — :l`l'1
Tax Map No. la-, / S / Q U
• Fee Paid S..
Owner's Name: Lt—V
Address: C 0 t A (
2. INSTALLER'S NAME : (7—4 ,L I-- 1 PHONE NO. lir I .7V7—2
3 RESIDENCE
ENC INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# 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 0 x 150 gal/bdrm = 1 SO
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes— / no
Spa or Whirlpool Installed yes / no JUL.1 9 2000
TOWN OF 0!'`E. BijRv
4. PARCEL INFORMATION: (circle applicable information &indicate measurements'I_Di A.D r;r, c
T� Qgraphv Soil N4ture Ground Water Bedrock or Impervious Material Dom stic Water Supper
1 lcji sa''nc— — at what depth at what depth inict,al
Rolling oam -- feet feet we I
Steep slope clay if well; water supply
%slope other from 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 tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: 1,O ' gallon (min. size 1,000 gal)
Tile Field: each trench fl. Total System Length: fl.
Seepage Pit(s): number of size of each: ft. by ( fl.
Size of Stone to be used: ii / 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 /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
circumstanc own y or on behalf of an applicant, shall be void.
I have read a regulations - respect to this apcatio and agree to abide by these and all
require is of the Tow�,in of a ueensbury'Sani .ry Sewe ge Disposal Ordinance.
4
: - —76SIC:X1
Signature of reonsible person Date
7: oo y
,. '' 'i''OWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (1 /vim.
Location 0/r o . 4v-e-/ 5 '
Date '7 I . Permit # J 6 • 6
,r
SOIL TYPE: Sand Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone /'\
SEEPAGE PI : N um.'e r- \0
Size - , ft. x Lam\ ft.
Stone size -
PIPING: Size Type
Bldg. to Tank -' &I°
Tank to Dist. Box ' 0 vi ao
Dist. Box to Field tili It& `t
Openings Sealed? / No . :Partial
LOCATION/SEPARATIeNS.
Foundation to Tang. I teet
Foundation to Absorption' eet .
Separation of Pits / eet
Conforms as per P1ot PlanNo
LOCATION SYSTEM ON/PROP
(circle •
Front - Rear - Left 'Side - Right Side
Middle F t - Middle Rear
COMMENTS: .
1
SYSTEM.USE APPROVED: • YE NO
Arrived: >
Departed: ! v
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Building Inspector
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