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2003-763 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,iNY 12804-5902 (518)761-8201. Community Development-Building&Codes (518)761-8256 CER�IFIC AIM OF COMPLIANCE' ' I'ernciit Number: Pz0030763 Date Issued: Tuesday, September 16,2003 This is to certify that work requested to be done as shown by Permit Number P20030763 has been completed. Tax Map Number:, 523400-300-01,6-0001-011.000�0000 Location: 216 FULLER Rd Owner: DEBORAH FERRANTI Applicant: DEBORAH FERRANTI This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF,QUEENSBUR Director of Building&Code Enforcement Al TOWN OF QUEENSBURY 742 Bay Road,Queensbuzy,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030763 Application Number: A20030763 Tax Map No: 523400-300-016-0001-011-000-0000 Permission is hereby granted to: DFBORAT-TFFRRANTT For property located at: 216 FULLER 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: DEBORAH FERRANTI Septic Alteration Residential 216 FULLER Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency 01JEENSBURY SEWER JAY SWEET Plans&Specifications 2003-763 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, September 15, 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 TI,wn of ee ajyu, 0� eptember 15,2003 SIGNED BY far the Town of Queensbury. Director of Building&Code Enforcement Application for Permit mit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use Location of installation: 4Q File Permit No. Tax Map No. F 45; 4'e ee Paid C5Z Owner's'Name: /b Y\-i-" .............................I..........­­1........................................ .......................... Address: .2. INSTALLER'S NAME PHONE NO. 7Y 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 19 8p-car PW0r--1 x 150 gal/bdim = 33 1980- 1991- x 130 gal/bdim 1991 —present x 110 gal/bdrin Garbage Grinder Installed yes Spa or Hot Tub Installed yes STP 4.' PARCEL INFORMATION: (circle applicable information&indicate measurements qONNN OIF Arils091 Too P-rai3hv Soil Nature Ground Water Bedrock or Impervious Material ornestic Water Su ly at'what depth at what depth Rolling loam feet —feet well 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: /& u gallon(min. size 1,000 gal.) Tile Field: each trench :�.......ft. Total System Length: /11, -.0........... Seepage Pit(s): number of size of each: _ft. by_ft. Size,�f Stone to be used: # depth or thickness feet 71 Bed System Size: x Alternative System: ( P7 JA V-6+e t1T length andlor size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each:_gallons f 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. 9— /Z — S at re of responsible person Date ._�� F CR) Septic Inspection Report Office No. (518)761-8256 Date Inspection re u t re d: Queensbury Building&Code Enforcement Arrive: pinart: 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia : NAME: P IT NO.: 3 LOCATION: SPECT ON: RECHECK: Comments and/or diagram Soil Typekefapd/)Loam- Clay Type of i unici a Well Water Waterline Well separation distance Other wells: ft. Absorption Field: Total length ft, Length of each trench Depth of trenches Size of Stone -Seepage Pits: Number EP 1 2 UO3 Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box el it Distribution,Box 1Y% Location/Separations Foundation to tank Foundation to abs2Eption. —QID ft. Separation of Pits Conforms as per Plot Plan VY_N Location of System on Property: Front Rear Left Side ght Side Middle Front Middle Rear System Use St/us: V Approved Partial Approved and needs to be re-inspected,please call the*Building&Codes Office Disapproved L:\SueHemingway\Buflding.Codes.Inspection,FORMS\Septic Inspection Rep6rLdoc January 28,2003 l M U1 p o Op 1� o . 05� 8 "1 have seen or'observed,.or believe I saw evidence of, all oble cts such as houses,.wells,trees; fences, etc•, 4 shown on this document. I also represent that I have personally measured the distances set forth on the diagram." { (F i DATE , 1 I SIGN A RE .� WEE TOWN OF NSBURY BUILDING & E REVIEWED BY DATE d~7 TOWN OF QUEENSBUPY BUILDING DEPARTMENT Based on odr limited examination, com liarr with our comments shall not e construed as indicating the plans and specifications are in full compliance with the..Building.Codes of New York State..'