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2002-494 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20020494 Date Issued: Friday,June 21,2002 This is to certify that work requested to be done as shown by Permit Number P20020494 has been completed. Tax Map Number: 523400-289-008-0001.063-000.0000 Location: 15 STONEGATE Dr Owner: ROGER&DONNA BROWN JR Applicant: ROGER&DONNA BROWN JR 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 E742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 1 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020494 Application Number: A20020494 Tax Map No: 523400-289-008-0001-063-000-0000 Permission is hereby granted to: ROGER &DONNA BROWN.TR For property located at: 15 STONEGATE Dr 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. Tyke of Construction Value Owner Address: ROGER&DONNA BROWN JR Septic Alteration Residential 15 STONEGATE Dr Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency Plans&Specifications. BP 2002-494 Septic system as per plot plan and specifications $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 20,2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town o(lu e e 20,2002 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,1VY 12804 (518)-761-8256 1. OWNER INFORMATION: :...................................................................................... Office Use Location of installation:. Tax Map No. 02g Cl/ -e�$! /A File Permit Na. - Owner's Name: r W G G f i'G7 /v- Li _..................................................-....-_............_-.................._............ ......: Address: / 5 S 7 O'V,�"G,4 7-zC .1 U N � 4 �dQ2 TOWN OF OUEENSBURY 2. INSTALLER'S NAME : F3UILDI G. NC-per'- NO. 3. RESIDENCE INFORMATION: (circle.year of dwelling, indicate 4 bedroom(s) and multiply# of bedrooms with applicable gallons per bedroom-to equal total daily flow) Year of House: No. of Bedrooms x ComRutation = Total Daily Flow ,1980 or older .3 x 150 gal/bdrm = � O 1980- 1991 x 130 gallbdrm = fi 1991'-present x 110 gal/bdrm = Garbage Grinder Installed yes / no 1-1_1�- Spa.or Whirlpool Installed yes_ 1 no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) Tonoaranhy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supnl- Flat sand at what depth at what depth municipal �o oam �feet feet wel Steep slope, clay ifwell;water s pply Yo slope other from-any-septic-system depth: absorption is�ft. other Percolation Test: (To be completed by licensed professional engineer t)-_ or architec tf Rate: minute per inch 5• PROPOSED.SYSTEM: For New Construction: All individual sewage disp osal posal 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: 11A' . ©gallon (min. size 1,000 gal) Tile Field:_ each trench �� ft Total System Length: ft. Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # t depth or thickness feet Bed System Size: x Alternative System:�.!rz�i4 vzcr �r <length and/or size - 6. HOLDING TANK SYSTEM: (if required) Number of tanks: ! Size of each gallons 1 TOTAL Capacity: gallons Nate:. 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. 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