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2004-174 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: P20040174 Date Issued: Tuesday, April 13, 2004 This is to certify that work requested to be done as shown by.Permit Number P20040174 has been completed. Tax Map Number: 523400-302-014-0002-076-000-0000 Location: 10 BULLARD Ave Owner: JESSE & KRISTIN HOWARTH Applicant: JESSE &KRISTIN HOWARTH This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY (�'j)emp/� A=— Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-59.02 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040174 Application Number: A20040174 Tax Map No: 523400-302-014-0002-076-000-0000 Permission is hereby granted to: TF.SSF.&KR1STTN H0WART14 For property located at: 10 BULLARD Ave 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. Tyne of Construction . Value Owner Address: JESSE&KRISTIN HOWARTH 10 BULLARD Ave Septic Alteration Residential Total Value QUEENSBURY, NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-174 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, April 13, 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 irown o Que April 13, 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: ............................... I© dc, / /`r// Office Use Location of installation: / G l.Gc 6 !!�� 1I� �/ File Permit No.Q-00 ` 1/y Tax Map No. J / i Fee Paid Owner's Name:_ C�s, c, l'T r J �'^ G y- .... .......................................................................................................................... Address: 16L"� Ac c 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATIONN: (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 x 150 gal/bdrm = d 1980-1991 x 130 gandrm = 1991 -present x 110 gallbdrm = RECIVELD Garbage Grinder Installed yes^ / no k `� Spa or Hot Tub Installed yes_ ./ no APR 13 Z004 4: PARCEL INFORMATION: (circle applicable information&indicate measuremen€ INN OF ? 'c-2NSBURY VILDINO Ai D CODE T-oumaDh e Ground Water Bedrock or Impervious Material Do Water Su 1 Flat g sand at w at epth at wr;eetth te nici a ollin m eet 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. �ko Septic Tank: t gallon(min. size 1,000 gal) Tile Field: each trench KO ft. Total System Length: Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: _# / depth or thickness feet Beal System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: I 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. 1j doe � ignature of respo sible person Date -Towit of (Iti(;Cli:llmi-Y 5rwcr;t urul 5c w;xi.c; I)isi msal Chapter nINVILV'IION, PII;M.) ' SI;I'/1ltA'I'IWIN Itl��Zi.3titi�[�II��I�'I` i ' I )tu* Pam) d . •• r'T 110uaE Q hE }t>�" it�atu�. G . E .. t 1. .) '� T1t1 tY �1 �• MINK _......_. 1 ` ���''J� �„r,,. 1 Ut'�iSttl�T i 1ST•T( ' y M�1 7 SIGNATURE &]NFOR14ATIQ O.I�I L � S�k'Vi�1,9'11� � • T . Mahone 0 BOX Notlfy-Plus Tnc,787 GLENS FALLS,NEW YORK 12s01618R93-7788 FAX:518/793-0602 INSPECTION COMPLETION DATE 141— 7-- O y CUSTOMER: SO Ln 14oe-v /4.5 h ?'s ADDRESS: /e /C� 1-"4 g,@- 64s r/ 07)a s Su J2.'l THE FOLLOWING FIRE ALARM DEVICES WERE TESTED DURING OUR INSPECTION OF THE ALARM SYSTEM: FIRE ALARM CONTROL BATTERIES FIRE ALARM CONTROL CHARGE CIRCUIT 1/ SMOKE DETECTORS HEAT DETECTORS MANUAL PULL STATIONS c/ HORN STROBES DUCT SMOKE DETECTORS STROBE DEVICES FIRE DOORS OTHER: ►u —r�vT w ` P(Z TRANSMISSION TO CENTRAL STATION AT THE TIME OF THIS INSPECTION, THE SYSTEM WAS FOUND TO BE IN OPERATING ORDER, DATE: N T DATE: OM ER / T0 'd TSbT 2VL STS T 51y6iaH N0W018S Wti TZ: OT VO-21-NJO /0 ,40 - Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: anl/p D art: 742 Bay Rd., Queensbuly,NY 12804 Inspector's Initials: NAME: 4tPAg:�4_& PERMIT NO.: �� 17 LOCATION: /d uL P_b INSPECT ON: / RECHECK: Comments and/or diagram Soil Type: a / lay Type of Wate : Municlpal Well Water Waterline se ara on zstance 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 Ik, Seepage Pits: Number Size: x Stone Size: Piping SiFe Type Buildingto tank ! Nf� Tank to Distributi Box 1( 35 Distribution Box t ield/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 V Y N Location of System on Property: Fro Rear. eft Side Right Side Middle Front Middle Rear System Use,4Stat : proved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 have seen or observed, or believe I saw evidence of, -. trees; fences; shown, an this document, I also represent that I have 'h L S 1ATU E IGNATU DATE APR 1 3 2004 TOWN OF QUEENSBURY _gUILDING AND CODE sapoo 'IS WoAft 0 ZulpynEj.3w 1114 U! 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