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2002-093 � a TOWN -OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 76.1.8256 nr DY rCOMPLIANCE uix i IFICATEOF Permit Number- P20020093 Date Issued; Tuesday,January 23,2007 This is to certify that work requested to be done as shown by Permit Number P20010093 has been completed. . Tax Map Number. 523400-302-014-0003=029.000.0000 Location; 22 JEROME Ave Owner. NYSARC,INC.WARREN WASHINGTON CO'S CHAPTER Applicant; WARREN-WASHINGTON ARC This structure maybe occupied as a; Septic Alteration Commercial By Order of TownBoard TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, Variance,or other issues and conditions as a result of approvals by the Director of Bdd*&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY j1jjjj742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020093 Application Number. A20020093 Tax Map No: ' 523400-302-014-0003-029-000-0000 Permission is hereby granted to: WARREN=WASHINGTON ARC For property located at: 22 JEROME 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: WARREN-WASHINGTON ARC Septic Alteration Commercial 79 GLENWOOD Ave Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET QUEENSBURY,NY Plans &Specifications 2002-093 SEPTIC ALTERATION AS PER APPLICATION $35.00, PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,February 15,2003 (If a longer period is required, an application for an extension must be made to the code Enforcement Officer Dated at the Town of bury; riday,February 15,2002 SIGNED BY for the Town of Queensbury. Director of Building&Co ^nfement 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.�� �Gx�: _,, i File Permit No;:Q�' Tax Map No. Fee 5 Paid Owner's Name:�%r�il �/ i ��/�r/f/?ter Address: 2. INSTALLER'S NAME ; , 5 �///� '/w ���y .�� PHONE NO. - f 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate 4 bedroom(s)and multiply# of ti 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/bdrm 1991-preset x 110 gal/bdrm = RECEIVED Garbage Grinder Installed yes_ / no - L--" Spa or Whirlpool Installed yes_ / no v' B 0 8 2002 4. PARCEL INFORMATION: (circle applicable information&indicate measurements)TOWN OF QUEENSBURY BUILDING AND CODE Too a h Soil Nature Ground Water Bedrock or IMRervious Material Domestic Water Su 1 at a at what depth at what depth munic' Rolling oam3' feet feet well Steep slope 'clay if well;water supply _/o 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: ��© gallon(min. size 1,000 gal.) Tile Field: each trench ft. Total System Length: Seepage.Pit(s): number of size of each: 1t. by ift Size of Stone to be used: #�/�t depth or thickness Ga - -%� feet Bed System Size: x Alternative System: ,.--- 5 '° length andlor size 6. HOLDING TANK SYSTEM: (if required) Number oftanks: / 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 whichis 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 ofthe Town of Queensbury Sanitary Sewage Disposal Ordinance. 41dria-ture of responsible person Date Septic Inspection Report Office No. (518) 761-8256 Date Inspection r ce Queensbury Building&Code Enforcement Arrive: m p part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initia s: J&�jyyne4,— Q-xA�j�, � ASC P R rr NO.: -200Z NAME: 4P LOCATION: N ECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/Clay Type of Water: Municipal/Well Water 2- i5J Waterline separation distance Well separation distance Other wells: Absorption.Field: Total lenqLh Length of each trench Depth of trenches 7�k Size of Stone See Pits: Number Size: x tA P, Stone Size: Piping * Size Type Buildin2 to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: Y/ N/ Partial End Cap Ej—�njeoutlet Pipes&Baffles Y N Location Separations Foundation to tank Foundation to ab orption Separation of Pits Conforms as per Plot Plan Y N En ineer Re rt and As-Built _Y_N Location of System on Property: Front Rear Left Side Right Side Middle Front .Middle Rear 51stem Use Stat Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Offlce Disapproved Last revised 021006 Last revised 1/6/05 +� P 4 0 4) CL V 0) 4) {) or. � �► 0 $- U) z 0 U 4J w I H 4J Q1 0 } Lit- 41 0 M C G tG 11 4) 0 d V) Ls. or r- r• i' U) 0 1% *0 z w Ix " aca V) I 0 1 4J Z 4J V) 4) , 4-10 CA o ro (0 4) E v 0 .!� 0Or-S 4- *0 00 ..I r" IX r C Sl1 ' Q. 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FURNISH & INSTALL (5) :-O FT. LONG W HIGH CAPACITY INFILTRATOR TRENCHES WITH MINIMUM 8 INCH STONE ON ALL r� Zp� SIDES OF INFILTRATORS. (SEE' DETAIL). (Y 11 t4. iI MIN. APPLER E II I I TO BE INSTALLED AFTER VARIANCE APPROVAL ONLY +1W PINE ntEE �Esr � lu u 9� CRA ASPHALT APPLE EE __ 20• 71.1 PINE TREE NYT A.LO.P.O.W.UNE _ O.NU.6 V. ---- 20•WHl7E g6 '--' O RAW TREE NM B , E.O.P. JEROME A VENUE P.P. W/ E O.P. ±" I 1 u (2)GUTS - 96 .. W W W O O D S mLLj r .i�ry:J 111 L s - 'INE TREE *PINE TREE I ()REPLACEMENT SEPTIC SYSTEM PLAN � o SCALE 1 30' J z I Q W Q i V II 1 I +) +J 4.) 0 6 a I vONL L 4.. 4. 4- � 4 , ; I � >. W I ,� \ CJ� N r N A L� 00 N � �- U)If-. 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