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2003-203 TOWN OF QUEENSBURY 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&.Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20030203 Date Issued: Monday, September 22, 2003 This is to certify that work requested to be done as shown by Permit Number P20030203 has been completed. Tax Map Number: 523400-309-011-0001-016-000-0000 Location: 24 GARNER St Owner: BILLY JO MEADER Applicant: BILLY JO MEADER 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 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 A BUILDING PERMIT Permit Number: P20030203 Application Number: A20030203 Tax Map No: 523400-309-011-0001-016-000-0000 Permission is hereby granted to: BILLY JO MF,ADF,R For property located at 24 GARNER St 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. Tie of Construction Value Owner Address: BILLY JO MEADER 24 GARNER St Septic Alteration Residential Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET_ 01 JF,F,NSBi JRY.NY Plans&Specifications 2003-203 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 23,2004 (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 Tow ueensb Sday,April 23,2003 SIGNED BY for the Town of Queensbury. Director of Building&&de En orcement Application for Permit—Septic Disposal System - Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: ........... ..................................................I................................................................... Office Use Location of installation: cQ L-1 Tax Map No. File Permit No.Q Fee Paid Owner's Name: .....................I.............................................................................................................. Address: V r'C', r J-,/ 2. INSTALLER'S NAME J-d 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. = 1980- 1991 x 130 gal/bdrrn = 1991 —present x 110 gal/bdrm. = Garbage Grinder Installed yes no 700k;* 2003 Spa or Hot Tub Installed yes no eUl QNGQUFCNS A/�p C FRY 4. PARCEL INFORMATION: (circle applicable information&'indicate measurements) I-eR-narai)hy S tune Ground Water Bedrock or impervious Material DQIZK ' ter Supply Fla '11'sandl at what depth at what pth munici d�-� --Rolling �oa m et eet —w-e-ff Steep slope clay -ej, if well; water supply %slope other from any septic-system depth: absorption is 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: Q100 gallon (min. size 1,000 gal.) Tile Field: each trench_ft. Total System Length: ft. Seepage Pit(s): number of size of each: -7�ft by g 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) 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. person Date,fnature of responsible - � 3 0 Septic Inspection Report Office No. (518)761-8256 Date Inspection quest r cei d: Queensbury Building&Code Enforcement Arrive: am/p ep a 742 Bay Rd., Queensbury,NY 12804 Inspector's Ini - NAME: _ E IT NO.: l.J✓w � LOCATION: L SPECT ON: RECHECK: 3 Comments and/or diagram Soil Type(Sand Type of Wa uniei /Well Water Waterline , ara 1 n distance ft. Well separation distance Other.wells: ft. Absorption Field: Total length ft. �'✓ Length of each trench ft. Depth of trenches ft• 3 Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size T e `'� Building to tank Tank to Distribution Box Distribution Box t eld it « Opening Seale Y/ Partial Location/Separations Foundation to tank ft• Foundation to absorption t. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front &Vft Side Right 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 LASueHemingway\Building.Codes.Inspection.FORMS\Septic inspection Report.doc January 28,2003 PDT Septic Inspection Report Office No. (518)761-8256 Date Inspection recl}ae receiv d: Queensbuly Building&Code Enforcement Arrive: ni/ D part: 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia . NAME: l A -� �C U Y P IT NO.: Cam' a03 LOCATION: ;( ECT ON: _ - RECHECK. , 1. Comments and/or diagram Soil TypK Sand oa Clay Type of a er: M u-nici-paIV Well Water Waterline se ara I ce _ft. Well separation distance ft. Other.wells: fl. Absorption Field: Total length ft. Length of each trench ft. 1 Depth of trenches ft. ` Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type UV 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 Conforms as per Plot Plan Y N Location of System on Property: <✓ \ '�� Front ReaL fide Middle Front Middle Rear �� System Use State Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:'6ueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doe January 28,2003 13) ��b u 5C � F 1 00 y TO of- WN QU ` is,---icy BUILDING & REVIEWED By DATE a. Y far 'VLD "I have seen or observed, or. Relieve I saw evidence of, APR � 2003 all objects such as houises; wells: trees, (emus, etc., "OWN Q F QUEEN shmAin on ffiis z=� .;; a;;r r,,�nresent that I I _ve BUILDING AN COD RY persom,al , ipasu.m <ances set forth the diagram." E SIGNATURE DATE t r � . tl