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2002-210 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804.5902 (518)761-8201 , Community Development• Building&Codes (518) 761.8256 COM LIANut 'E " r ' nrD'V rA nr Permit Number: P20020210 Date issued: Thursday,April 04,2002 This is to certify that work requested to be done as shown by Permit Number P20020210 has been completed. Tax Map Number; 523400-301-013-0002.014-'000.0000 Location 4 BRAYDON Ave Owner. DIANE ERCQLN Applicants DIANE ERCOLINI This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OP QUEENSBURY Director of BuildinkEn TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes .(518) 761-8256 BUILDING PERMIT Permit Number: P20020210 Application Number: A20020210 Tax Map No: , 523400-301-013-0002-014-000-0000 Permission is hereby;granted to: DIANE ERCOLINI For property located at 4 BRAYDON 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 incompliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. . , Twe of Construction Value Owner Address:- DIANE ERCOLINI Septic Alteration Residential 4 BRAYDON Ave Total Value QUEENSBURY,NY 1280.4 i Contractor or Builder's Name f Address Electrical Inspection Agency SANITARY.-SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY F Plans &Specifications 2002-210 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.06 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,April01,2003 (Ifa 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 owl ijueensbb Monday,April 01,2002 / f SIGNED B)�' for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bav Road Queensbuzy NY 12804 (518) 761-8256 1. OWNER INFORMATION: _.......__... -........................__......................_._........... ._. ......_.............. Office Use Loc;e1iori o4 installation: 41 zpX� �24- 11) File Permit No: � l Tax Map No. s r Fee Paid Owner's Name: t �G C G��I / _............ :........- --............... -..................._.. Address: _� y�©!Ll 2. INSTALLER'S NAME v r �<c � PHONE NO. Y11r�tD 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of MAR )002 bedrooms with applicable gallons per bedroom to equal total daily flVL"itbl 0.OOP Year of House: No. of Bedrooms x Co utation = Total Daily Flow 1980 or olde x 150 gaUbdrm = S 1980—1991 x 130 galtbdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no X Spa or Whirlpool Installed yes_ t no _ 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) To o ra h Soil ature Ground Water Bedrock or I envious Material D is Water Su 1 TZ t and at w at depth at hat depth munici al Rolling ;loam A// feet feet we 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 thes_ ize of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Fx'is4mnf Co4/C)-e -/C Septic Tankon gallon(min. sz a 1,000 gal.) Tile Field: each trench 110 ft. Total System Length: Seepage Pit(s) number of size of each: ft. by ft- Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: L..��6��—�� en th andlor 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. Signature of responsible person Date 518 745. 4437 FILENo.;G38 04,,02 '02 :AM"1.1:.25 ;I D;TOWN OF 9UEENSBURY FAX:518 745 4437: PAGE 1 Applicsttion for Permit--Septic D1000+r61 system Town.of,Queensbury 742 Bay Road Queensbury,NY 12804 (318) 761-8256 ^_ _ 1. O'WNER INFORMATION;'.' Location of installation: File Permit No. Tax Map No. Fee Paid �.v� (Z f hf-►fir rfL rt) Owner's Name: _.... Address: 2. INSTALLER'S NAME d. PHONE NO. 7��'7s?`( 3; RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroomfir) and multiply# of bedrooms with applicable gallons per bedroom to equal total dailyflaw) . VELO ' 1980 or older x ISO gaUbdrst� 0R Q 2 � 1980—1991' x 130 gal/bdrm - i 1991 —present x 110 gal/bdrm ■* TOWN OF OUEENSBURY Garbage Grinder Installed yes— / no nwr` AMID Spa or Whirlpool Installed : . yes, / no - 4, PARCEL INFORMATION: (circle,applicable information&indicate measurements) .NYat . at what depth at what depth unicipal Rolling oam: feet feet Steep slope cla if well,water supply ; other from any septic system ib'slope depth: absorption is ft. other Percolation Teat: (To be completed by licensed professional engineer ar architect) Rate: minute per inch S. PROPOSED SYSTEM:, ForNSw- CoUir 'c ;on: All individual sewage disposal systenu must be designed by a licensed professional cngiueer or.architect(unless installed in a plaruting Board approved subdivision).,,Add 230 'gallons te�;the size of the scpdc tat*and leach field lbr each Garbage Grinder,Spa or Whirlpool Tub. .,, % CSC/ `JAj Septic•ram• r gallon in. size 1,000 gal.) � jyGrG,�1/t-iZ7Qr f • Total System Length: ft Tile Field: each trench •1t Y� , Seepage pit(s): -number of, h size ofeach: _fit. by } Size of Stone to be used: # / depth or thickness feet T Bed Systerri Size: x Alternative System length and/or size 6. HOLDING TANK SYSTEM:.(i£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. SIt3NATCTRE INFORMATION FOR RESPONSIBLE PERSON(please read) For your protection,`please note that pursuant to Section 136-29 ofthe Code o£the Town of Queensbury,any permit or approval grarrted-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 r the reguistions with respect to this application and agree to abide bythese and all roquir oats the'Y'owa of bury Sanitary Sewage Disposal Ordinance.. / CT 21, 8 Oats gnsture of rasa n,;ew,T person P 00 or- 4- Q 4- U z w - 4- � W I In � � `I1 „ d z 0 �, U c I ar L�, `r 4 :) w � I , '0 a. P Z 0 10 as m 0 �s � E � °� c�.� 0 cn�-� 4- *0 w 0� J r tl: S. r G N C. w Ul , i 0 C� a Q�c�� ro sa'r �- J � G N .. �� , -C O 'r " dl—d0. -.� r 4J ��S 0 r W H U C v I �.,. 0' 0 4- 0..0 IOU, ro 0 U) C +J 0 (ZIP � 0 Oz a) O IN b In a) I� 0 4''' 4. U 4J 4J H 0) F- to I~ e c to 0 a). w ° W 0 .�. 0 6� V11 N �.,� X `'� 0 0 o C'' to u C y A. r M# 0 4- 11, 0 0 0 ,r-•r- �r ch LL V) � r I■I H 0 ` 0 Q,LL 10 4-w U) 4-) 0 M 04 P P S E 0 cD I i', I;► w w0OWoQvC04MY PcItcc04- S C*0 0 E U P H o4-LV) caNWNOL -0Cu1 (UUZ :3aCU 'r0 '0X N (d 0 it 0 O'r• >m Q) Q).r-W -r- +) H r— M 'r ( 0 0 0 a) 00 U S- 'r 0 � �• � z in0ulNlnLmQ - 0O..JLLLLV}Ua,--*GLZU N �C� t t i0 TOWN . F UEFA SBUI-Y QD REVIEWED BY �r�'rt3a� DATE A 1303 10 �Zr "I have seen or observed,or believe I saw evidence of, all objects such as houses,wells,trees,fences, etc., shown on this document. I also represent that I have rso ally measure he istances t forthZD m:" SIGNAT E