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2003-901 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: P20030901 Date Issued: Friday, October 31, 2003 - -This is to certify that work requested to be done as shown by Permit Number P20030901 - has been completed. Tax Map Number: 523400-295-019-0002-028-000-0000 Location: 16 OWEN Ave Owner: THOMAS MOSCHETTO LIVING TRUST Applicant: THOMAS MOSCHETTO LIVING TRUST This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY (f. J 4 Director of Building&Code Enforcement 7r TOWN OF QUEENSBURY 171 742 Bay Road,Queensbiiry,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030901 Application Number: A20030901 Tax Map No: 523400-295-019-0002-028-000-0000 Permission is hereby granted to: THOMAS MOSCHETTO T,TVTNG TRTTST For property located at: 16 OWEN 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. Type of Construction Value Owner Address: THOMAS MOSCHETTO LIVING T 16 OWEN Ave. Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency T.B.S. SEPTIC 2 LOWER WARREN STREET OTTEENSBURY. NY Plans&Specifications 2003-901 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS • $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, October 30, 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 exp4iration date.) Dated at the T o ueen h , October 30, 2003 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbuty 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use Location of installation: /(r�`} (,t, , ALL Tax Ma No File Permit No. t1(J qo 1 p / / Owner's Name: O 5-(- c 710 • Fee Paid RECEIV Address: (( © (,�.. OCT 2 200 Tt�VNPJ OF Ol,'-FN a!3o_1F 2. INSTALLER'S NAME : �. ��, �k 5-4) , C PHONE NO. �tJll_f�lf�(G ®C®®� 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply II 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 3 x 150 gal/bdrm = 1980- 1991 x 130 gal/bdrm = 1991 -present x 110 gal/bdrm = Garbage Grinder Installed yes— / no Spa or Whirlpool Installed yes— / no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) raphy • 'i• ature Ground Water Bedrock or 1m ervio s Material _ ater Supply Flat san, at whqst depth at at epth municipal ling loam feet , ,j 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 e.ch Garbage Grinder, Spa or Whirlpool Tub. _ I UA si1 Septic Tank: 16 D0 gallon (min. size 1,000 gal) Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s): number of )__ size of each: l ft. by 9 ft. Size of Stone to be used: # $ / depth or thickness ,5". 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 anon any material mierpnreeentatinn nr FaiL.ro trs • Septic Inspection Report Office No. (518)761-8256 Date Inspection reque g: Queensbury Building&Code Enforcement Arrive: p !-part: y:pr an �m 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia • NAME: VI1t l-AETtc) NO.: 2_003-alb 1 • LOCATION: \La, 0 F ANV X_1VE SPECT ON: 10 - :,i -N3 RECHECK: • Comments and/or diagram Soil Type. San Loam/Clay Type of Water: unisi-al Well Water Waterline separation distance ft. Well separation distance (I A ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench • Ili ft. R 1-013 LS> E) 5- \ Depth oftrenches ft. Stone 3� � Size of P� Seepage Pits: Number _ 7— Size: -�-x� - LrC j"� °= ►� -T-�S� " Stone Size: *- '� ERAMTV—to Piping Size Type • Building to tank E`-16T1 \C-* Tank to Distribution Box y tEri 13C-, � Distribution Box to Field/Pit L1 " PVC, Opening Sealed:O 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: • Front Rear Left Side Right Side . Middle Front Middle Rear System Use St4tus: ✓ 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 1 36(- co. Septic Inspection Report Office No. (518) 761-8256 Date Inspection request eive : Queensbury Building&Code Enforcement Arrive: a m art: t ,y 742 Bay Rd., Queensbury,NY 121 04 Inspector's Initial . _ - NAME: se.\-\�% PE IT NO.: 2 0 LOCATION], to >�� 1 � INSPECT ON: / D - j -03 RECHECK: • Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water 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. \Wi A"---57 " Size of Stone 6 Seepage Pits: Number c`�-' �� Size: x Stone Size: • Piping Size Type • Building to tank • Tank to Distribution Box " 4J/ Distribution Box to Field/Pit Opening Sealed: Y/N/Partial i*C `zc 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 Middle Rear • System Use Stat s: 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 . a .kkia • Septic Inspection Report Office No. (518) 761-8256 Date Inspection re s re iv d: Lv r 63 Queensbury Building&Code Enforcement Arrive: m/ m epart: an M. 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi s: NAME: p(JS G k 4 IT NO.: LOCATION: 1CoG.}P�� �!�� SPECT ON: p G 3 RECHECK: • Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. F s.ti�11 � �� Absorption Field: Total length ft. T Length of each trench ft. Fr R RJ�`- �` Depth of trenches ft. Size of Stone • Seepage Pits: Number Size: • x Stone Size: • Piping Size Type 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 Middle Rear System Use Sta s: 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 • "I have seen or observed, or believe I saw evidence of, all objects such Is houses; wells, trees, fences, etc., 1' shown on this uoc,umnt. 1 aiso represent that ! have personaiiy .easured the distances set forth on the diagram." / e. c° SIGNATURE DATE nY A Iri 0 CI extift, br() o Xci • . . to 0� ` cuyf • .') 6) f�vS REVIEWED B, DATE ,:;w;,01:, . 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