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2002-509 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: P20020509 Date Issued: Wednesday,June 1.9,2002 This is to certify that work requested to be done as shown by Permit Number P20020509 has been completed. Tax Map Number: 523400-308-012-0002-050-000-0000 ~-- Location: 64 PINEWOOD Rd Owner; RICHARD CARPENTER Applicant: RICHARD CARPENTER 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 742BayRoad,,Queensbur)4NY12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020509 Application Number. A20020509 Tax Map No: 523400-308-012-0002-050-000-0000 Permission is hereby granted to: For property located at: 64 PINEWOOD Rd in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other infonnation hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: RICHARD CARPENTER Septic Alteration Residential 64 PINEWOOD Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications BP 2002-509 Septic Alteration as per plot plan and specifications $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,June 19,2003 (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 of .Wesbu r June 19,2002 SIGNED BY r the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System -,eY 7bim of Queell-yb I fly 74213qj11?oadQr1 eel Isbuty, NY 12804 (518) 761-8256 Aff I. OWNER INFORMATION: ................. • Location of installation: Office Use File Pannit"No. Tax Map No. > /19 —50 Owner's Name: 4d r Fee Pat ................ .......... .................. Address: 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, intfictrie it be.-11-ooin(v)atj(j multiply ll of Year of House: bedrooms with applicable gallons per bedroom to equal total dailyfloJ01V 9 No. of Bedrooms x Computation Total Daily -IVAVIV OF 1980 or older CODE x 150 gal/bdrin = 1980- 1991 x 130 gal/bdrin = 1991 —present x I 10 gal/bdrin = Garbage Grinder Installed yes_ J no Spa or Whirlpool Installed yes— J no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) Td6Z�nraoliv p4mature -arotLiLd Water 13ed[qpk or fin rvious Material 11water Sul 11y Sall at Pth —�,am` eet ',et Sleep slopeIling Clay if well; water supply slope other septic-system any septic-syste depth: absoiption is other Percolation Test: (To be eompleted by licensed professional engineer or architect) hate: -millille Per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems intist be designed by.] licensed professional engineer or architect(unless installed in Plaltuitig l3oardal-4)roved stibdivisimi). Add 250 gallous to the size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: gallon(min. size.1,000 gal.) Tile Field: each french >a J1. Total Systern Length: ao 6 it. Seepage Pit(s): number of size ofeach: _fl. by Size of Stone to be used: it depth or thickness Bed System Size: x Alternative System length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: J Size of each:_gallons I TOTAL Capacity: gallons Note: Alarm System and associated electrical work niust,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 tiposi or is granted in reliance upon any material misrepresentation or failure to snake a material fact,or circumstance known by or on behalf of an applicant, shall be void. I have read the regulations witi, rosPeettothis application atrcl agree to abide bythesoand all req"irements of the Tows of Queensbury Sanitary Sewage Disposal Ordinance. 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