2002-300 r'
TOWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761.8256
CERMT1 IFICATE OF COMPLIANCE
Permit Number: P20O203O0 Date Issued: Tuesday,April 23,2002
This is to certify that work requested to be done as shown by Permit Number P20O2O300
has been completed.
Tax Map Number: 523400-303-016-0001-003.000-0000
Location: 387 DIX Ave
Owner: MARTHA&EDWARD BRACE
Applicant: MARTHA&EDWARD BRACE
This structure may be occupied as a:
By Orderof Towti Board
Septic Alteration Residential TOWN OF QUEENSBURY
Duectero .k1'" 1 forcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020300 Application Number: A20020300
Tax Map No;: 523400-303-016-0001-003-000-0000
Permission is:hereby granted to: MARTHA&EDWARD BRUCE
For property-located at: 387 DIX 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: MARTHA&EDWARD BRUCE Septic Alteration Residential
360 SWANAGE Dr Total Value
C/O ADAM, SYLVIA
BROOMAL,PA 19008
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY.NY
Plans &Specifications
2002-300
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,April 23;2003
(If a longer period is required,an application for an extension must be made to thecode Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of�juee b g1sArF3,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application.for 11'ermit—Septic Disposal System
,Town of Queensbilty 742 Day Road Queensburj;NY 12804 (518) 761-8256
1. OWNER INFORMATION: ........................ ....:.....:........................................._..................................
(Hike Use
Location of installation:
File Penttit No.
Tax Map No. / /
Fee Paid �S "
Ownor'a Nacho: i .....................................................................................................................................
Address: ��
2. INSTALLER'S NAME : `r/� ? _ � / PHONE NO. RECE11 ED
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate It bedroonl(s) and multiply t!'o,>A PR 2 2002
bedrooms with applicable gallons per bedroom to equal total dailyfloty)
TOM\ n NSBURY
; ��r
Your of Hausa: No of Bedmoins x Computation = Total Daily Flow BUILDING hsi it)CODE
1980 or older x 150 gnl/bdrm =
1980— 1991 x 130 gai/bdrin =
1991 —present, x 110 gal/bdrin =
Garbage Grinder Installed yes` / no -1-A—
Spa or Whirlpool Installed yes / no I
4. PARCEL INFORMATION: (circle applicable information &. indicate measurements)
�rili2llX_ tS!_t9 Q.t44rtt(t V�.!ntvr. _134.St.!ot~k.,4r�list�ot:XJ944S�tt.l4rie'11---IJor)ipstic W:St.Vrlll��11'i'ty
�'lcr sate ur t}/it? thytt/r at %%/r I I jrth r rrr !pert
Cftltiig crm /t// Jeettfect iv el
Steel.)sloe clay if well; water.sripply
slope other froin airy.septic!.cystenr
depth: absorption is
other t
Percolation Test: (To be cotnpleted l)y licensed prt fessiotial e►igltieer or arcliltect)
Rate: nilnute per Inch II
5. PROPOSED SYSTEM: For New-Construction: All individual sewage disposal systems must be designed by ii liccriscd
professional engineer or architect (unless installed in a !Tanning Board approved subdivision). Add 250 gallons It tile size
of the septic tank and Icach field for cach'Garbage Grinder, Spa or Whiillx%oi Tub.
Septic`Tank: . OZF42 gallon (min, size 1,000gal.)
Tile Field: each trench fT. Total System Length: �a fl•
SeepagePit(s): number of size cifeacli: _fl. by /1•
Size of Stone to be tined: lt —___•—_` / depth or
Bed System Size: x
Alternative System: length 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 pursttrtttt to Section 136-29 of Uto Corte of the Town
of Qucensbury, any porn%it or npprovnl granted which is based upon or is granted in
roliance upon any material m%srepresentatiol% or faiture to ninke n material fact or
circumstance known by or on behnlf of nit applicant, shall be void.
I have read tite roguintions will% respect to tills npplicntion nttcl ngroo to nbidoby these and all
requirements of tite Town of Quecusbury Sattitary Sewage Disposal Ordinance.
000p -�
SighiMure of responsible person Date
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i
1
OS M
RECEIVED
V C- APR 2 3 2002
OWN Or QUEENSBURY
BUILDING MCCODE
C
ell
{�d
PLC
C.
C."I. JVim'
"t 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
personally,measured the distances set forth on the diagram"
CA/'.
SIGNATURE DATE
Sat .
a°
13
' VED
C, APR 2 3 2002
OWN OF QUEENSi3llRY
BUILD
ING AND CODE
T �,` ` ` Wit= "I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells,trees,fences, etc.,
BUILDING � C� � shown on this a tired the distanceent. I also s set forth on the diagram:'
REVIEWED BY.. peresent that I have
rsonall me
DATE DATE
SIGNATURE