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2004-276 TOWN OF QUEENSBURY ��� Qr 742 BayRoad,Queensbury, 12804-5902 (518) 761-8201 r3', Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20040276 Date Issued: Monday, May 10, 2004 This is to certify that work requested to be done as shown by Permit Number P20040276 has been completed. Tax Map Number: 523400-227-010-0001-024-000-0000 Location: 20 BEAN Rd Owner: JOHN GLASS Applicant: JOHN GLASS This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY (---3atriP 4 Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040276 Application Number: A20040276 Tax Map No: 523400-227-010-0001-024-000-0000 Permission is hereby granted to: JOHN GLASS For property located at: 20 BEAN 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: JOHN GLASS WENDY SEVERANCE Septic Alteration Residential Total Value 18 OAKWOOD Dr NEW HARTFORD, NY 13413-2458 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-276 SEPTIC ALTERATION $25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, May 04, 2005 (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 or9uee61:1 , . , May 04, 2004 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: Office Use Location of installation:a?C Au n Rel; ({u. 1611 et ovr Tax Ma No. / / (II File Permit No. O�' �6 P Fee Paid c' '' Owner's Name: YAvi-. GIG, <�j Li).'3 s.fe,VQYfk.11C . Address: 2. INSTALLER'S NAME : Cs/a c,Clan (tee/ P1 ,-. 7C PHONE NO. 7f3 3/ 3. RESIDENCE 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 •80 or olde x 150 gal/bdrm = 7-S`o 1-L 1980- 1991 x 130 gal/bdrm = 1991 -present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no K Spa or Hot Tub Installed yes_ / no A URNt TO ' r TEE 4. PARCEL INFORMATION: (circle applicable information&indicate measurements ) 5 _ - Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flat sand at what depth at what depth municipal ollin loam feet feet well eep 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: r CO° gallon (min. size 1,000 gal.) Replace,,. v-�') n '� ,,.4- r�!cc c fe— Tile Field: each trench �, ft. Total System Length: ft. Seepage Pit(s): number of size of each: ft, by \ ft. Size of Stone to be used: ;''''''-------____ / depth or thickness�_.� feet Bed System Size: x \ Alternative System: \ ''''-----______length and/or size 6. HOLDING TANK SYSTEM: (if required) s. 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. V .1(-'7 cl nature of responsible person f Dati& „r,,, ,'I own of (.1tiootlralsui-y qni }' Scnvers :trill 4e v; j',e I)itipo :tl (;11:1 p)irr•. AUpriuti x ( . • A.B.St)It,PT1()N IV'I I.II,I) • . SI':I'ARA'l'1WN ItEQl.;I Rini I';N1'I ' ..‘c,..,....S.:70i NM , „,--,... .i — ...Z., Cf,5),- ......) ilk; __SLK I POND y'1�1.L IN /(►(lS'rt• \ .i �I lc'r4d llljtrt1►1 en �•- • 1 ' )4 ..•••-”' ►bu ac G At. , �,,1>'v' :�%tr>u�st:. G G . . E (c"...•:. roar. � '� 1. ' SC('I IC, •� i ,� �� 'r ll�t W.. 1 / I A 1: w . try 010,1w,r r • • .••.•• .ram ��« ...•.. • / . 7. SIGNATURE &INFORMATION FOB.R I'uN J..sLZ,rzza zw,. v.,a..-..••••v Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/p part: /1'.56pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: 1p 4--. -1j 5 PERMIT NO.: © - 24 LOCATION: /4,-,� 0• INSPECT ON: S (Qa' RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. 7 aw-r Well separation ace �• ft, l/y',J�� 4,61w--Aukitit Other wells: g 6— 6 . ft. Absorption Field: Total length ilit.. Length of each trench Depth of trenches Size of Stone Seepage Pits: Number Size: x Stone Size: • Piping Siz , Type 0 Building to tank !f.G4 Tank to Distribution Box k •• Distribution Box o Field/Pit 2" h Opening Seale.ION/Partial Location/Separations Foundation to tank /0 ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: i li Front Rear Left Side Right ''.- Middle Front Middle Rear C-,4y7 4 1 p( System Use Statu ✓✓Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:'\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/irdp , -,art: am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: '1- NAME: j�j PERMIT NO.: O 277 LOCATION: (4-A) R , INSPECT ON: RECHECK: • Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water --FA/OK— oL,C Ewe Aj Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type % f I b Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan +_Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Mid e Rear System Use Status: proved artial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingwayU3uilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 7_ , (,----- _____ , f, 6co l'' -g IIII i ,(; -,,. 1 , . ,, , REv, 4 EC) BY „ ,r7-. /-- ' DATE ~' l i ' ' -t--: ' I TOWN OF QUEENSBURY BUILDING DEPARTM NT Based on oUr limited examination, LIN, compliance with our comments shall 1 not be construed as indicating the 1 :,,`k . plans and specifications are in full CD \ compliance with the Building Codes of New York State. 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