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2002-612 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: P20020612 Date Issued: Monday,July 22,2002 This is to certify that work requested to be done as shown by Permit Number P20020612 has been completed. Tax Map Number: 523400-296-0IM001-023-0000.0000 Location: 86' SWEET Rd Owner: DANIEL YAKUSH Applicant: DANIEL YAKUSH This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QVEENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURYFIL 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 E Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020612 Application Number: . A20020612 Tax Map No: 523400-296-018-0001-023-000-0000 Permission is hereby granted to: DANTF,T,YAKTJSH For property located at: 86 SWEET 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. Tape of Coristruction Value Owner Address: DANIEL YAKUSH-; ' CABBIE GRIFFEN Septic Alteration Residential Total Value •,. , 86 SWEET Rd QUEENSBURY,NY 12804 Contractor or Builder's Name"f Address Electrical Inspection Agency nT JFFNSBT JRY SEWER JAY SWEET Plans&Specifications 2002-162 Septic Alteration for residence as per plot plan and,specifications $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 22,2003 (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 uee ury; on , ly 22,2002 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application fur-Permit,--Septic Disposal System r Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 8256 1. OWNER_ INFORMATION: - Of£ce Use Lo ram' Location of installation:. I . Fi emut.No. Tax Map No. / / D" l lVFeePaid Owners Name 1 � '� �I� .............................-..-. Address �v L� \� -�UEENSBURY 2. INSTALLER'S NAME': s "=-t PHONE NO. L l � Q 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s)and multiply# of bedrooms with-applicable gallons per bedroom to equal total dailyflow) -Year of House: No of Bedrooms x Computation. = Total Daily Flow 1980 or older x 150'gal&,dnn = 1980-1991 x " 130 gal/bdrm = 1991-present X,- 110 gallbdrm = Garbage Grinder_Installed yes Spa or Whirlpool Installed yes 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Tpg og=hv Soil Nature Ground Water Bedrock.or_Inwervious Domestic Water S_uVR1v C:29REF at what depth at what`depth Rolling aoam feet feet well Steep slope clay: tfi ell;water supply _%slope' other from any septic-system depth: absorption is other Percolation Test: (To,be completed by licensed professional engine er 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 Tankz6lJCJ . gallon(min.size 1,000 gal.) All.(rd:-each each-Tench_-� Total System Length:, O-Z-3 ft Seepage Pit(s): number of. size ofeach: ft by 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 oftanks:_ / 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 Sa INFORMATION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section 136 29.ofthe Code,ofthe 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 ofthe Town of Queen sb Sanitary Sewage Disposal Ordinance. Slg ature 40 kesponsible person Date T TOWN OF QUEENSBURY BUIEVING A-_CODE ENFORCEMENT 742 Bay R"ad Queensbourry NY I2004 (518D0 761-8256 SEPTIC DISPO.SAU SYSTEM IINSPECTIoM L o c a t i on Date '""'� -- P e rm i t SOIL TYPE a _ oa --I�' Resin tS of Per oZ at! n Test-- ( i -�' appl icabl e � Rate Ai n€.t-te/Inch TYPE OF S YSTEN ASSORPTI ON FI EL To a 7 b o n g t-h Length of each t enc L- e Depth of trenches [ Size of stone N SEEPAGE PITS : N urn a r- Size - ft _ -F= t Stone size PIPING: Size Type Bldg . -t cs -lank t4 yj sj—��� Tank- to Dist _ Box Dist _ Box to Fi eI d/P ' Openings Sealed?— Yes o Parrt1 EOCATI ON jS EPARATZ Foundation to Ta-nk ►S_ feet Foundation to Ab sorp ti on feet Separation of Pits et Conforms as per Pl o-t Plan es o I_OCATI ON OF SYSTEM ON PROPER Y ( ci rcl e one ) Front -- Rear - Sides i ght de Middle F r-on t Middle Rea r COMMENTS z SYSTEM USE APPROVED-- YES NO Arr-i Vd I3epa r Su4 7 d i ri O I c t:©r- 1 I have seen or observed,or believe I saw evidence of, all objects such as houses, wells,frees,fences,etc,, shown on this document. I also represent tNt I have ersonally measured the distances set forth on the dig,lam." 'IGN&RE DATE �W C �m Q Q/ LUw LU 1) 0 _ om TOWN QF QUE URY BUILDING & eT . REVIEWED BY L) DATE t y'_ • I •