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2002-403
1` TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804.5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CAR IFICATE T OF COMPLIANCE Permit Number: P20020403 Date Issued: Tuesday,May 21,2002 This is to certify that work requested to be done as shown by Permit Number P20020403 has been completed,. Tax Map Number: 523400-302-017-0001.029-000-0000 Location: 18 WINTERGREEN Rd Owner: LAWRENCE&JOAN HULL Applicant: LAWRENCE&JOAN HULL 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 QUEENSBURY 742 Bay Road,Queensbury,NV 12804-5902 (518)761-8201 Community Development-Building&Codes -(518) 761-8256 BUILDING PERMIT Permit Number: P20020403 Application Number: A20020403 Tax Map No: 523400-302-017-0001-029-000-0000 Permission is hereby granted to: LAWRFNCE&JOAN HULL For property located at: 18 WINTERGREEN Rd 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: LAWRENCE&JOAN HULL Septic Alteration.Residential 18 WINTERGREEN RD:QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name Address Electrical Inspection Agency COOKS SEPTIC Plans&Specifications 2002-403 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,May 20,2003 (If a longer peiiod is required,an application for an extension must be made to the code Enforcement Offirzer of the Town of Queensbury before the expiration date.) Dated at the Town of Queensbury; Monday May 20,2002 SIGNE I3Y ector o Co for for the Town of Queensbury. Application for Permit—Septic Disposal System Town of Queensbury 742 Bav Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: - ---•- ----- Office Use Location of installation: v, v ,! 1 File Permit No. , `I.o� I { Tax Map No. Fee Paid ` Owner's Name: 11q V 7�Z// Address: 2. INSTALLER'S NAME C PHONE NO. yJJ 3. RESIDENCE INFORMATION: (circle year of dwelling;`indicate#bedroom(s) and multiply# of p bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House-, No of Bedrooms x Computation = Total Dailv Flow 1980 or older x 150 gal/bdnn = 1980—1991 _ x 130 gal/bdrrn = 1991 —present x 110 gal/bdrm g Grinder Installed yes = s ( Garbage < / no C I ` — Spa or Whirlpool Installed yes_ I no MAY 2 ® 2002 4. PARCEL INFORMATION: (circle applicable information&indicate measurementsyOWN OF QUCENSBURY P,U_jw_pING AN_ _—D GC1'Jt1 Tgnq&=hv Soil-Nature Ground Water Bedrock or LnVervious Material Do jc Water S9PPlV at s at what depth at what depth munic olling oam feet feet well Steep slope clay ifwell;water supply Y.slope other from any septic-system depth: absorption is - ft. other j Percolation Test: (To be completed by licensed professional engineer or architect) ' Rate: minute per inch I 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 Vhirlpool Tub. Septic Tank: gallon(min. size 1,OOD gal.) GSj (/ Tile Field: each trench ft. Total System Length: fl Seepage Pit(s): number of size ofeach: ft. by�ft Size of Stone to be used: # / depth or thickness feet Bed System Size: _ x ��/�'_ �`� �^ Alternative System:� i v'i^ length and/or size - 6. HOLDING TANK SYSTEM: (if required) Number of tanks: J 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 ofthe Code of the Town j of Queensbury,any permit or approval granted-which is based upon or is granted in J 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 re ect to this application and agree to abide by these and all requirements a own of ee sb S nary Sewage Disposal Ordinance. �� I tgnature of responsible person u Date I 1 too OZ 1 pp A i-) (V 0 Q) r C� w -C r �' �, l ^► `� U � .0 w v C� W H 4N» O N 0 fro cn . NCL x � W -P a C •�- a W +J (U F- C I C ro 19 00 U U. b 'r U C X it *A 0 r-it 0 Rcr. 9J z z 0�, �, I 0 or r 11 CL o1 4J.0 41 z 0 QJ Vi W 0 E . or- Q) 0U N v, 4J r, w N WO 0 03 E. � t V 0.1 � � WA3 H G4 W r Z S. 0 ; r o ICI C 0 4J t . 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I 0 G +J v z 4- 0 v (u.0 0 >~ b U J .c M ,r r"'7 "r NEWZ u I U. v v I t fig Q„ 4r v r W H u c 0I I ,�C �-•a C? 0 '- C1.Idi `! : ;, p+" c , cn a. .n�» . c v c vs c 0 ro o �., . 4J r `Q Z 04 troy c v �s�S �0y(� Al d 0 4J Ow �+ UI L6� 4) fro{ /cy 1 H ", 4» u 4J T' H a) �"' "r- v) V I r11. c c iv O c W 0 W ' W 0.r 0 4- �a N 0 x � 0 0 0 0 I� �. r� p � � Vy of W W C a r W 0 4M "r 0 0 0 "r"r +r !�. 0 � ;� �� , t� �0.IL� 0 4-�Wp ;A '� #-) 1©1 M D 4' -P P �" m IJK r % �N .c C� 41 `Z " r• �, `C3 'O S. 0 * U �r-W vT' w > W N ro v al WCt7)� NC� vc ► CA.Y +� C � CCctS -< S C `0 r V) E U +) H 04- CLIACD. NWN0170C0O O 'OFI So. 0 0 t 0 v•r 'M v v'r W .r. 4J H r rtl "r- (10 0 0 v 00 U S."r- o ;M 3. 0 z .J o V1 tY�F�; J I i/I� �to m l— C� �W U. Lt.v} ,}W •ta. N P "I have seen or observed,or believe I saw evidence of, all objects such as houses,wells,trees,fences,,etc., shown on this doc I al represent t forth on a diagram." persona y ea red t t if !t SIGNAT RE DATE _ HEI VED r �C MAY 2 D 2002 Li _1*1