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2001-042 TOWN OF QUEENSBURY Fos 2 B Road ueensb NY 12804-5902 518 761-8201 74 aY ,QY, ) Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010042 Date Issued: Tuesday, February 06, 2001 This is to certify that work requested to be done as shown by Permit Number P20010042 has been completed. Tax Map Number: 523400-101-000-0002-013-000-0000 Location: 1 BULLARD Ave Owner: ROGER PALMER Applicant: ROGER PALMER This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY ( eleta 4 Director of Building&Code Enforcement " TOWN OF QUEENSBURY Foo 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010042 Application Number: A20010042 Tax Map No: 523400-101-000-0002-013-000-0000 Permission is hereby granted to: ROGER PALMER For property located at: 1 BULLARD 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: ROGER PALMER Septic Alteration Residential LOIS TEDESCO PALMER Total Value 1 BULLARD Ave QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET OUEENSBURY.NY Plans &Specifications 2001-042 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday,February 02,2003 (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 Town f Que sb rid. , Fp ruary 02,2001 SIGNED BY irl .I 41, for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Septic Disposal System Town of Queensbiny 742 Bay Road Queensliury,NY 12804 (518) 761-8256 ' 1. OWNER INFORMATION:.' 2 #, Location of installation: /-3C--- � Office Use ((-0t � ��C Tax Map No. / ' I, File Permit No. / ` D-- • Owner's Name;, -ro 1/4, (' � c .� Fee Paid- JC, Address: / - / i 6> (CFr---cI 6t C�c, 2. • INSTALLER'S NAME : • J— t , SpIG p_� PHONE NO. ��� (��j Y • • 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/bdnn = VI-0 1980- 1991 x 130 gal/bdrm = 1991 —present - - x 1.10 gal/bdrm = Garbage Grinder Installed yes / no _ Spa or Whirlpool Installed- yes / no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) �,•,..grnolly S.,:.,I.atm) grsa ndV.4!alo.C_.__PCSir.gck.or ImperykonsAtaterkalUompslic W.atcr_S11pply ep .:, ere at titer depth al II' a eplk insaticlpal oiling n .. . feel . ' . eel well Sleep slope clay if well; water.supply ,__/o slope other from any septic-system • depth: absorption is fl. 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 ii licensed . professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 25O gallons to Ike size ' _,,`,, of the septic tank and leach field for each Garbage Grinder, Spa or Whirlixwl Tub. . - Septic Tank: 4 5-0 gallon (min. size_1,000 gal) Tile Field: each trench�� ft. Total System Length::22a_____. i. . . Seepage Pit(s): number of size ofecich: ft. by fl. i •Size of Stone to be used: ll a- • % depth or thickness feel 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. s 1: 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 those and all requirements of the To of Queensbury Sanitary Sewage Disposal Ordinance. V . .6./e • . _. , o� nature of responslb a person '. ' Date: • TOWN OF QUEENSBURY BUILDING &_CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 • (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 1:)--.125 ac2fry\,97/ Location _ \ o y Date r —ac()J Permit #1 ,1e1))-OLPN- SOIL TYPE: San -Lo `-Clay- Results of Percolation -st- (if applicable) Rate- inut- Inch TYPE OF SYSTEM: ABSORPTION FIELD: Tot. l Lengt Length of each trench �b efj /Q5eJ' Depth of trenches /-Z.' Size of stone SEEPAGE PITS: Number-IIW Size - ft. x mar ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box ,gam Dist. Box to Field/Pi " ( Openings Sealed? OP No Partial LOCATION/SEPARATION . Foundation to Tank /0 feet Foundation to Absorption zj feet Separation of Pits Conforms as per Plot Plan ers No LOCATION OF SYSTEM ON PROPERT (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: for,/ eft fro"- SYSTEM USE APPROVED: NO Arrived: //. 5'r Departed: Building Inspector TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name u eh'1 Location v/ Date 0/4 Permit # 01 DLO-- SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist, Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption _ feet Separation of Pits _ feet' Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right S:ide Middle Front - Middle Rear COMMENTS: s-ep Ls-L �r h �v SYSTEM USE APPROVED: YES NO Arrived: icW Departed: . , "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 ., , ;,..,. • personall/asured thit distances set forth on the diagram." .Lfidil(_ __. ,,....,,r,,. . • SIGN&TURE DATE v elj‘el- ---- . . .. .- .- .-.. _. , . . . 55 0 ,, • . _. . . _ .. . : ,,,, .. .• . . . , . .. , . ... . . , coo . , .,..._y / 1 ' . , . . 1 • (:----------.' 2.0 • TO . N OF QUEb: BURY 1 • BUI- DING & COD .c-..,-‘ a,a1'EPT. . Er, (kc1 ( - • REVI1•WED. BY (-"ai taj DAT: . A . .ff ' . • . --- .. . ••,.,,,, . . . ,-.- Pd1711'0 ' --i - . t 6 1 oll1 „.-.