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2001-512 TOWN OF QUEENSBURY tvi'm 742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010512 Date Issued: Tuesday, July 17, 2001 This is to certify that work requested to be done as shown by Permit Number P20010512 has been completed. Tax Map Number: 523400-301-007-0001-061-000-0000 Location: . 22 CENTENNIAL Dr Owner: LYNNE C BOECHER Applicant: LYNNE C BOECHER This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY (-3J/i Director of Building& Code Enforcement 1 TOWN OF QUEENSBURY Foro 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010512 Application Number: A20010512 Tax Map No: 523400-301-007-0001-061-000-0000 Permission is hereby granted to: LYNNE C BOECHER For property located at: 22 CEN 1'ENNIAL 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. Type of Construction Value Owner Address: LYNNE.C BOECHER Septic Alteration Residential 22 CENTENNIAL Dr Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency Plans &Specifications 2001-512 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,July 17,2002 (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 own o Que byty; e a my 17,2001 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, NY 12804 (518) 761-8256 1. OWNER INFORMATION: �C2 6/�//ea'"(//4 Z ,D,P/de i Tice Use Location of installation: �tl 1l,SJ� File Permit No. IJ Tax Map No. / / D hi f/id5 Zdkre''lle�a�- • Fee! Paid �-g�io Owner's Name: � Address: /v; '/ ,,e'l e &5nf-J 2. INSTALLER'S NAME : ,r/�yDie'l/ /d/� PHONE NO. 7 f `d 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply II 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 ? x 150 gal/bdrm = 5'D 1980- 1991 x 130 gal/bdrm = 1991 -present x 110 gal/bdrm = Garbage Grinder Installed yes / no RECEIVED Spa or Whirlpool Installed yes / no JUL 1 G 2001 4, PARCEL INFORMATION: (circle applicable information &indicate measurements) TOWN OF QUElNSSURY Tope raphy SoiLisla ure Ground Water Bedrock or Impervious. .,.Water Supply Fla sands at what depth at what depth municipal) o ling loam feet 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: /eC e gallon (min. size 1,000 gal) Tile Field: each trench %l'r 3 ft. Total System Length: cP / fl, 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-andfar-size /,c/,62 Z ,2 ,.S felS/Ei-( f 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. J° • (., Y-7-e7 Tv Si natur of res• •nsible person Date TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 J (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 136C Cir(e.l2 Location Z2— ( NiCN/qL Date 71/4) I Permit # — 5 (2_, SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Tot. :ngth Length of each trenc- Depth of trenches Size of stone /,u fffilEA-c--OG S SEEPAGE PITS: Numb: Size - ft. ft. Stone size PIPING: Size Type Bldg. to Ta . Tank to Dist. Box Dist. Box to Field/'it Openings Sealed? Yes No Partial LOCATI ON/SEPARATION• : Foundation to Tank. . .feet Foundation to Absor.tion feet Separation of Pits -_ feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: L Q b l`r C-C !-, SYSTEM USE APPROVED: YES NO Arrived: - Departed: Am (?P Building Inspector TOWN OF QUEENSBURY . BUILDING &_CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 r (J (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name M e . 0OeC r Location Date -7 l- i Permit # /— r-'D-- SOIL TYPE: a d-Loam-Clay- Results of colation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM. ABSORPTION FI" LD. Total Length Length of eac , tre h Depth of trenc es Size of stone SEEPAGE PITS: umbe - Size - ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box " `xr� 2 0 Dist. Box to Field/4 ik U. Openings Sealed? No Partial LOCATION/SEPARATIO Foundation to Tank feet Foundation to Absorpti cn c'__ feet Separation of Pits feet Conforms as per Plot Pl a No LOCATION OF SYSTEM ON PRO'ER (circle one) Front - Rear - Left Side - Right Side Middle S � l\A _— COMMENTS: 22 J SYSTEM USE APPROVED: YES NO Arrived: Departed: Building Inspector pow TOWN QUEEWSBURY BUILDING & CODE ENFORCEMENT //c) 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name cL6 b� Location n\m ) ,)/0 Date l/' 1 Permit ;_pol -5)(1..._.,. SOIL TYPE• and- -Clay- Resul is of Percol a •ion Test- (if applicable) R.te- inute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each tr:nch Depth of trenches Size of stone SEEPAGE PITS: Num�•er Size - ft. , ft. Stone size _ , PIPING: E '-ize Type Bldg. to Tank 4` NC -T-r) L1"<,U{9C Tank to Dist. Box t D< < p Dist. Box to Field/Pit Openings Sealed? 'Its No Partial ar ial LOCATI ON/SEPARATI OVS: \cot)ALo Foundation to Tank E e i rL a feet Foundation to Absorption feet Separation of Pits eet Conforms as per Plot Plan Ye No LOCATION OF SYSTEM ON PRO' Rom` (circle one) Front - Rear - Left Side Rig Side Middle Front - Middle Rear , COMMENTS: IIII L SYSTEM USE APPROVED: YES 0 Arrived: ' Dep Building actor Id I �� `)bk �b lf\ie� • pa,,,,,,, /N . ,r_ /D ,e.„._ //o_� 6�d4' h "I have seen or observed, or believe I saw evidence of, all objects such as houses,wells,trees,fences,etc., shown on this document I also represent that I have personally meas .ed the dista set forth on the diagram." ' Co:::.)f 'TUBE 7-1�-a� DATE I 9 ir ,a refi-ii-1 _ yeova I / 'y ��" -�� lJ 81 - I I ,f%6` 61, -- 0 lb 4 ill TOWN OF QUEEN§',B RY 2 Oii our limited[?Xanilnciiion� F'',;'i;alir,:•,1 NJltii OUf CC i1ita sn Il REVIEWED �oD�G// G/ L �1t J cnstr�ers in�iiGI?:n fha DATE Q � � �'�i!s a�ld s�ecificatiorls in fi�il c :i; Ii�nc �.ith t± !old