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2001-290 TOWN OF QUEENSBURY g144..ro 742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010290 Date Issued: Wednesday, May 16, 2001 This is to certify that work requested to be done as shown by Permit Number P20010290 has been completed. Tax Map Number: 523400-114-000-0009-003-000-0000 Location: 7 QUEENSBURY PI Owner: CHARLES &KAREN HARRIS Applicant: CHARLES &KAREN HARRIS This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY t, Director of Building&Co e En cement 1 ��� TOWN OF QUEENSBURY %,70s 742 Bay Road,Queensbury,NY 12804 5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010290 Application Number: A20010290 Tax Map No: 523400-114-000-0009-003-000-0000 Permission is hereby granted to: CHARLES &KAREN HARRIS For property located at: 7 BENTLEY P1 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: CHARLES &KAREN HARRIS Septic Alteration Residential 7 QUEENSBURY P1 Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency CONDON SEPTIC & DRAIN SERVICE Plans & Specifications 2000-290 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,May 14,2003 (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 " to ensb ; VIon ,,► ay 14,2001 • SIGNED BY c -`A for the Town of Queensbury. Director of Building&Code Enforcement -4 Application for Permit—Septic Disposal System Town of Queettsb2tt y 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: fir. . . �' "�-*"9 "since Use 1 Location of installation: y,"/ MA r Tax Map No. / / 1'O� q�l bile Wiffi No. (QJ�9V Owner's Name: ,� - ..„.- ,,D Address:/3 A604) PAS a J • 2. INSTALLER'S NAME(104 J/Y S, r ,oG, 'Ai 6 `,.,./fse*, PHONE NO. .gr��r 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# 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/bdrm = x/10 ':0- 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes / ` Spa or Whirlpool Installed yes / . 4. PARCEL INFORMATION: -(circle applicable information&indicate measurements) T.L.graphs' Soil ature Ground Water Bedrock or Im ervious Material Domestic ater Su 1 Fla sand aj what depth at wh t depth unici�l 'oiling oam �1' feet 41 feet well Steep slope clay if well; water supply _%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: yt 1.,, • gallon min. size 1,000 gal.) Tile Field: each trench jr 0 ft. Total System Length: Q ft.J4'A/7 471�/5 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: 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. 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. ti V_p _cl/d r---a/ gnature of responsible person Date TOWN OF QUEENSBURY iv" BUILDING&CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION /> /frJ-5 Nameij ril 5 Location Date ' / / Permit - �C, SOIL TYPE• San oam-Clay- Results of Per{ol .tion Test- (if applicable) Ra ' --Minute/Inch TYPE OF SYSTE ABSORPTION FIE D: Total Lengthia d Length of each trench i 501-- Depth of trench s/ `J Size of stone . \/Av / 7 7" )/� SEEPAGE PITS: N .er- Size - f . x ft. Stone size PIPING: -� ize Type Bldg. to TankK/5i/� Tank. to Dist. Box 4/ X - C) Dist. Box to Field/' ' i1 Openings Sealed? &Y-: No Partial LOCATION/SEPARATION• Foundation to Tank feet Foundation to Absorpt'on U feet Separation of Pits _ feet . • Conforms as per Plot Plan es No LOCATION OF SYSTEM ON '"ROPERTY: . (circle one) Front - Rear - ft S ' - Right Side Middle Front - Middle R-ar COMMENTS: SYSTEM USE APPROVED: YE NO Arrived: . - / Departed: t7 • St.7)!, Building Inspector lv ` � O "I have seen or observed, or believe I saw evidence of, all objects such as houses,wells,trees,fences, etc., V �.I shown on this document I also represent that I have a e; `� Personally measured the distances set forth on the diagram." 57tZO/ SIGNATURE DATE Z Z E9k L-1 0"---N (\ a - ' \..) a ,40‘ ZCIL) (i --- -\..) s 3l (-1 ( $0 ,ke (33M3IA H I d 6 ‘Zett. v r -/- tom. I '.. %'r's, . 1 ) Q?3 f. ,�..: t- 1 -a , ,17 6/ �, NI . 1002ill T T AVN . ) , w , it U 1 L