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2002-604 TOWN OF QUEENSBURY - 742 Bay Road,Queensbury,NY 12804-8902 (518)761-8201 [ILE OPI Community Development-Building&Codes (518)761-8256 r CERTIFICATE OPCOMPLIANCE Permit Number::. .P20020604 Date Issued: Monday,July 22,2002 This is to certify that.work requested to be done as shown,by-Permit Number P20020604 has been completed. Tax Map Number:", 523400-309-015-0001-047-000-0000 Location: 48 CAROLINE St Owner: MICHAEL WELLER Applicant: MICHAEL WELLER 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 BayRoad,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes, (518) 761-8256 BUILDING PERMIT Permit Number: P20020604 Application Number- A20020604 Tax Map No: 523400-309-015-0001-047-000-0000 Permission is hereby granted to: For property located at: 48 CAROLINE St in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other infortnation hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. - Type of Construction Value Owner Address: MICHAEL WELLER Septic Alteration Residential 48 CAROLINE St Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency Plans&Specifications BP 2002-604 Septic Alteration as per plot plan and specifications $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,-July 15, 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 a sbuMo a 15,2002 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,IVY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use Location of installation: 07 0 File Permit No.,aOQ Tax Map No. Fee Paid Owner's Name: ............ .................. ................................................................ Address: 2. INST.ALLER'SNAME PHONE NO. ME __X , IV (circle year of dwellfg, indicate 9 bedroom(s)3. RESIDENCE INFORMATI� .and multiply# qrtjL 1 5 20,12 bedrooms with applicable gallons per bedroom to equal total daily flow) TOWN OF Q! N'JEE, Year of House: No. of Bedrooms x Computation = Total Daily Fl SSURY AN Q C 0 0 E 1980 or old er i6� 2— x 150 gal/bdrm = Z::z 1980-1991 x 130 galfbdrm = 1991 —present x 110gal/bdrm = Garbage Grinder Installed yes no Spa or Whirlpool Installed yes i I no 4. PARCEL IN-FORMATION: (circle applicable information&indicate measurements) Tot)oiz rah v Soil Nature Ground Water Bedrock or Impervious Material Doinastk Water SUpply at what depth at what depth municipal feet. well - olli et e C_*Rieepslope clay if well;water supply Yo slope other from any septic-system depth: absorption is ft other Percolation Test: (710 be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systeins 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,tafik and leach field figr each Garbage C-inder,Spa or Whirlpool Tub. Septic Tank:, 46T­0 gallon(min. size 1,000 gal.) -7 Tile Field: each trenc Total System Length: Seepage Pit(s): number of size ofeach: —ft. by_ft. Size of Stone to be used: depth or thickness. t Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: i 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 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. 45 Sf-ginaureof responsible p on DAte f :•Ii�tihI Of (21=4--r.rrairtrr-y aciv(:rs ,trtLl :i4`tV;tJ;t3 I)i:;i>OsaI (:ha�rtrr Appendix C 11.I3.S(1It,V I'ION. PJ UA olI) SE'PARNI'IU)N ItI;CjI_?IItI;I�II�:N'I`�; n �� - �•`fit? 1- poN� W v'J _iL'IN Tl/1T1''R- • 'l1t}ttT C,/�s tr tL..; -- J'r•`.�..�. 4 �rt 1-t'rt••, ►�uz 0 n �GT�a/E 47 Ij \- 1+2Y�tTRP r1Gl 3 —l— Rrmt) _ _ . . 7. SIGNATURE &INFORMATION FOR"511UNbU=-r-rni..vvx. �xv<.n..•••-•:i i�ix� (0 4J -P4-) 0 0 r 4) 0 NZ -0� � 0 4a- o~ � U? F� \ 4J w ` c - 4 ' z N 0 a IN g u Q �!-� Q1No 0r I W W i 0 � 41 Va LL m r. r- ,t r„r tlJ N U Lzu I>. E CL z 1 0 Oro 0 W 'i� > } N 'r- tU O U N �{ a, 11 +J r 0 cc 0 fu (0E ' '0 $ J - 41 � W .CU 'r �� )I © ro Or-WH U t N .. � U� r 0 0 tU ! 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