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2003-930 V TOWN OF QUEENSBURY1. . 742 Bay Road,Queensbury,NY 12895902 (518)761-8201 Community Development Building&Codes (518)761.8256 Ea -LIFICATEC Permit Number: P20030930 Date Issued: ' Friday, November 07,2003 This is to certify that work requested to be done as shown by Permit Number P20030930 has been completed. Tax Map Number: 523400-309-0454001-025-000-0000 Location: 35 THOMAS St Owner: KENNETH MINER Applicant: KENNETH MINER 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 QUEENSBURYY 742 Bay Road,,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P26030930 Application Number: A20030930 Tax Map No: 523400-309-015-0001-025'-000-0000 Permission is hereby granted to: KFNW.TH MINER For property located at: 35 THOMAS 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. Type of Construction Value Owner Address: KENNE'TH MINER 22 HUDSON Dr Septic Alteration Residential Total Value SO. GLENS FALLS;NY 12803 Contractor or Builder's Name./Address' Electrical Inspection Agency STEP1 EN BARODY 792-0138 NY 12804-0000 Plans&Specifications 2003-930 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25,00 PERMIT FEE PAID-,THIS PERMIT EXPIRES: Thursday,November 04, 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 of Q ns ury; ay,November 04,2003 SIGNEDBY for the Town of Queensbury. Director of Building&Code Enforcement Applibation for Permit Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: Location of installation: Sr Office Use Tax Map No. A3 i File Permit No. Fee Paid Owner's Name: .................................................... .................................... ..................................... Address: 2. INSTALLER'S NAME PHONE NO. 75:P--ol-yAl L/ 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 ofBedrooms x Computation Total Daily Cgg:or or x 150 gallbdrm _19qd 1 x 130 gal/bdrm = 1104 , 1991-present x 110 gal/bdrm Garbage Grinder Installed Spa or Hot Tub Installed yes no' yes_ no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) no2ranhv Soil Nature Ground Water Bedrock or Imi3ervious Material Domestic Water�Su �11 t at what depth at what Domestic vv -dapth` unic* a Rolling -ro—am t well Steep slope clay if well; water supply %slope other rfiom 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: /M ' gallon (min. size 1,000 gal.) Tile Field: each t"reTich -fit. Total System Length: ft Seepage Pit(s): number of size of each: t.by_ft. Size,f Stone to be used: W 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 Mote: 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. ure �ores�p�nsible person ate S-':o-wert and Swvstj;c. Ilbsj oral t:Itssjster 1 ppotitlix t• ; pow D �ti'f�„iL tN �!�►Tt!'f{+ _i �'����r,,,,�„/' rl tt'rwt . _ � Imo• i .�"' Sc v,1c,AY.. i � 7ss • t+�,,csstt+txa s ttun.ta 7♦ SZGN,�4."I~UI�E SL SjFOIiM�►ZZt'��FOIE.�ti;,'a�vri�,l•>:ss�����vsi�La,».V<Y..Y,••�♦ '�'�♦:. r Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm" art: am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: _ NAME: C1PERMIT NO.: LOCATION: Y� INSPECT ON: RECHECK: 71 Comments and/or diasram Soil Type. S Clay T e of Water: unicipa 1 Well Water Waterline separ ance ft. Well separation distance ^ft. Other,wells: ft, Absorption Field: Total length ft. Length of each trench Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Sizo Type, Building to tank c Tank to Distribute 1 Box K c+ Distribution Bo icld/Pit sc .i y O enin Seale . Y N/Partial ' Location/Separations Foundation to tank ft. Foundation to absorption t. Separation of Pits t. Conforms as per Plot Plan Y N Location of Syste n Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Stat Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Sepfic Inspection Report.doc January 28,2003 0 _C* 06 0 � I J-700 p p zm A, / ? am N (216 oC LO M� a � r ©cam � c kA �k �� CF n �4 1 1lMn �7}, REVIEWED g "I have seen or observed,or believe I saw ej'ke o .��... c s suCn as nouses,wells,trees fences etc,, E DAT � Q shown on this document.I also represent that I have per IIy measured t�e distances set forth on the diagram," .1 SIGNATU p `I