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2003-010 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: P20030010 Date Issued: Friday, January 17, 2003 This is to certify that work requested to be done as shown by Permit Number P20030010 has been completed. Tax Map Number: 523400-296-017-0001-030-000-0000 Location: 19 GREENWAY Dr Owner: GAIL BRUCE-ROBINSON Applicant: GAIL BRUCE-ROBINSON 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 (EL 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030010 Application Number: A20030010 Tax Map No: 523400-296-017-0001-030-000-0000 Permission is hereby granted to: CTAIL BRUCF,-ROBINSON For property located at: 19 GREENWAY 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. T"e of Construction Value Owner Address: GAIL BRUCE-ROBINSON 19 GREENWAY Dr Septic Alteration Residential Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET OT JF,F,NSB1 JRY.NY Plans&Specifications 2003-010 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,January 16,2004 (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 n of eens4 u da January 16,2003 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 0 File Permit No,�X3 to Tax Map No. Fee Paid Owner's Name: 9 6-rc r Al ...................................................................................................................................... Address: 66. rrc- /20 2. INSTALLER'S NAME PHONE NO. 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 1980 or older x 150 gal/bdrm. = C, E 1980- 1991 x 130 gal/bdnn = IVED 1991 -present x 110 gal/bdrm. = Garbage Grinder Installed yes no JAN 1 6 ZG03 Spa or Hot Tub Installed yes_ no TOWN OF QUEENSBURY BUILDING AND CODE 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) T,k;oP-raDhv S6fl­Nature Ground Water Bedrock or Impervious Material -Denwsttz-Water SUDDIV Flat sand( -s-a­nd!,,) at what depth at what depth municipal) Rolling et feet 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:/&0—gallon (min. size 1,000 gal) Tile Field: each trench ft. Total System Length:Do 0 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: t1- /mot' ct� 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 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. Signature of respons%le person Date Tow f1 of (111ct411sbury sq%vers s111(1 5ewsiite Disvosat (ais�t�lt•r Appi-11(lix A-U.SOM"'VIO r�i 1,1�1 . • SI1'I1RA'1'1C)1N 1�:1;(�l.)I1tI�h]I��N'I`;i • HfEtt_ ur Nhrx c�• �—r G . rs u'n•.r - .. _ � _ 'rx'r�tr cnSi►Ire �`�... �•,••- ISou sr" G QE , ��;,,>�'• I I�.��s1= t 'r" O N D. ................................. 7. SIGNATURE &1NFopMATION FO-FUSIIUN�ixoLz rz"%,L tt�,����•.....•, � 3 Septic Inspection Report Office No. (518) 761-8256 Date Inspection requestreMve Queensbury Building&Code Enforcement Arrive: ?�%iz: ep =ZU a m 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia s: '- NAME: 1 PERMIT NO.: LOCATION: INSPECT ON: RECHECK: Comments and/or diagram J1 Soil T : .Sand Loam/Clay Type of Wate . Munici /Well Water ' Waterline se ara ion distance Well separation distance ft. j Other wells: ---- ft. l� Absorption Field: Total length ft. Length of each trench 7ft�+ Depth of trenches i L ft. Size of Stone �J Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank - •�� - '-F Tank to Distribution Box s� Distribution Box t,6 Eheld,,/'Vit Opening Sealed/Y/ /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 ear �eftde ight Side Middle Front Middle Rear System Use Sta s: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved I I I i, II I I ' o avEE�SpDE 1 TOW L©LNG p,ND C rh ve seen or o sdrved, orl beli.eve I salaide rice f, I-o jecis such 4s7h,ous�S,V lls re s, ences, etc., o�+�o. .#his-documentl-also-repreg ent-tha�H p rs nal y as 6red the di an-ces_setjo'l"n-the-d ag I SIGNATURE--' I I I®p IE )-. non —FEE_�_ON-ED� —DATES—�--! — 1 I IIII IIII I I I I � D I � I , I i I I, I