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2002-713 TOWN OF ,QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761.8256 s CORTIFICATE OF COMPLIANCE Permit Number: P20020713 Date Issued: Ffiday,August 23,2002 This is to certify that work requested to be done as shown by Permit Number P20020713 has been completed. Tax Map Number: 523400-302-017.0001-002.000.0000 Location: 15 ARBUTUS Dr Owner: KEVIN&CONSTANCE MINER Applicant: KEVIN&CONSTANCE MINER This structure may be occupied as a: By Order of Town Boatd Septic Alteration Residential TOWN OF QU.EENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8261 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020713 Application Number: A20020713 Tax Map No: 523400-302-017-0001-002-000-0000 Permission is hereby granted to: KEVTN &CONSTANCE MINER For property located at: 15 ARBUTUS 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: KEVIN& CONSTANCE MINER Septic Alteration Residential 15 ARBUTUS Dr Total Value QUEENSBURY,NY12804 Contractor or Builder's Name/Address Electrical Inspection Agency MTT.T,FR 14TT.T,TRIJCKTNO NY 12804 Plans&Specifications 2002-713 Residential septic alteration per plot plan and specifications. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 23,2003 (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 To n of eens d ust 23,2002 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,NY 12804 (518) 761-8256 1. OWNER INFORMATION: .............................................................. Location of installation: Office Use Tax Map No. File Permit No. 2_002_'-7t3 Fee Pid-4'7, Owner's Name: .......... ....................................................................... Address: 362,41-7- 2. INSTALLER'S NAME PHONE NO. 213 �Z9c)_5 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply# of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Cg=utation = Tot al Daily Flow 19804rXE-dip x 150 gaVbdrm = (00 1980-1991 x 130 gaVbdrm = R.ECENED 1991 —present x 110ga"ch-m Garbage Grinder Installed yes no AUG 2 3 2002 Spa or Whirlpool Installe I d yes no TOWN OF QUEENSBURY BUILDING AND CODE 4.*- PARCEL INFORMATION: (circle applicable information&indicate measurements) Too t)hv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water SMpl2ly t �fy�� at what depth at what depth feet - - munieipa 0 q6,loam go feet well Steep slope clay tf well;water supply %slope other from any septic-system depth: absorption is_ft. other Percolation Test: (To be completed by licensed professional engineer or architeco Rate: minute per inch 5. PROPOSED SYSTEM: For New Co struc4 : 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: 4,16 n gallon(min. size 1,000 gal.) Tile Field: each trench 5-o fit. Total System Length: Z.., Seepage Pit(s): number-f--*— size of each: fi, by_ft- Size of Stone to be used: # depth or thickness feet Bed System Size: Alternative System: length and/or size 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 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. Signature of responsible person Eyate •'F-<Llt'tt l>.r �21xL•(1x14E)Lxt�v ' S(! :xx)t1 (:i)rxj ler Alxl)(!t)(lix t= A[3.5t)MI'VION UPI FAA) BOND t Y IPA lle-rrrt- :�—S ra vI 1 So ntYxnsc'xrc�, age- t; 7. SIGNATURE &INFORMATION FQR R SYVtv�usi, rnr�v,. ��o�. •.••••, M nro 4J4� 4-) N a �4J Uj C) 4~ 4- V) ` V w c t or v1 ' � 0 w LP o N I I (A 4J 0 �;, W Q r QUJ 5W >y 1 "` N E or4) OU 0x 4 } " Q � N a +� +� v !� �� � c of—woori U l or- U lL G1 looll m m V) 0 �- U it U) +j 0)w c 0 I a 4- U)- 4J T' M v J— or" M/ V I 1r U W 0 W W 0 r 04— N 0 M \ 0 00 OW S. ICI N 4j aOL -C 00 1 0 4J cU e Z ti � p„ � r- � � �.0 < N CM � �f � �Mr 0�' 0 cd a .J, o W0M� 04Nc rn� ��C c r-W w ,> � W ro U 4j M cn4-40cC. N-WNOD. -aCv, a) u : flcU,r, 0-0 N f- 0 C Q1'r-)" M 4) tV or-W-r � H r-. qr V} • 0, z -j o V) c�• � (ZV) 0 ncnamF-© oJLLLU) � 1y�U RECEIVED IS &7,e3vj AUG 2 3 2002 ew C3 Z:l 1110Aai-11. TOWN OF QUEENSBURY IIl.UITILP AND gQDE Vb Al i �wA � Fai 1r �1+wr 4i 4C rywl �?if L I GMEP In R1 VIEWED BY b D TE ,.._�_ _ 23 t '°I have seen or observed, or believe ) saw evidence of, all objects such as houses, wells, trees, fences, etc., shown on this document. ) also represent that l have p .rsonally measured the distances set forth on the diagram." y 4 SIGNATURE �" /104F­