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2002-775 TOWN' OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE FCOMPLIANCE � Permit Number: P20020775 Date Issued: Friday, September 20,2002 This is to certify that work requested to be done as shown by Permit Number P20020775 has been completed. Tax Map Number: 523400-295-019-0001-071-000.0000 Location: 10 WESTMORE Ave Owner: DARRIN ROBERTS Applicant: DARRIN ROBERTS 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 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020775 Application Number: A20020775 Tax Map No: 523400-295-019-0001-071-000-0000 Permission is hereby granted to: DARRTN ROURTS For property located at: 10 WESTMORE Ave 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: DARRIN ROBERTS Septic Alteration Residential 10 WESTMORE Ave Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency STGNORFLIJ. ANT14ONY Plans&Specifications 2002-775 Residential septic alteration per plot plan and specifications. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, September 17,2003 (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 own 0 September 17,2002 SIGNED BY 4�tl for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit- Soptic Dispos�USyo-to In U \,0- , Iotvn of Qrteenshttly 742 Jlrrylturrd Qrtee»sGru},NY 12804 (S'/8).7G1=82S.6 1. OWNER INFORMATION: 4 A1e5�V�e _ ' 002 Urtice use Locution of LtsWllation: �� i 'r.'£�t- , w Tax Mnp No. flL?• lo:,I'oititlit`-IVo:�r 20 Z-'77�" Owner's Natno: /� 4�P-f t3 E' f Fea P n i d ' /J Address: c'� f'e. ° 2. 'INSTALLER'S NAME : f®"V yl r 5-aja c PPONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 11 bedroom(i) and multiply 11 of bedroarrrs with applicable galloitr per bedroom to equal total daily floiv) Xoar of Houses No, of 13odrl2oi is �t�s; p�►IIz►tiou = 'I l Daily Flow 1980 or older x 150 gallbdrnl 1980— 1991 x 130 gal/bdrin 1991 -Present x 110 gni/bdrm • Garbage Grinder Installed yes i / no Spa or Whirlpool Installed yes / no 7 4. PARCEL INFORMATION: (circle applicable inforniation 8Z indicate rneasurenterats) Lilly 11C9._-- t1.t'v.und•VY.ntoi__ �Il.pctrgck.o!'.�lnpw_Ytc�tt&_h't.4.lGraitl . r _ 'it0r'_$41JtJ)fy 1'rr tat:rl fit tr/tfN thdrill ell Sr•hut th-pt/r ntt'r��)t/c//rrrl lufhny, ortnr "feet Steep slope clay yr' !fwell; water sujrply Vo slope other = fi oat a►ry sc/ufc-systcrtr depth: _.- absolpttan is Ji. other Percolation Test: (To be conipleted by licensed pre/esslonal dig neer or architect) hale: 111111111C Per Inch 5. PROPOSED SYSTEM: For Newt/Constructlon: All individual sewage disposal systenls Iuust,be designed by h licensed proressiounl cri ineer or archilect (unless inslnlled-ill a 1'lannin1;13uard ah{iroved sulxlivisiori}. Adt1,25(1 galltiils In the sirs or Ilic septic lack and lcach field for c:1ch(;arbage Cat iuder, Spa or W hil iix)of't'u1). ' Septic Tank: gallotr (rrtin. size I,000 gal.) Tile Field: each trench J49 fl. 'Total System Length: p � fl, Seepage Pit(s): number of size of each: by Jt. Size of Store to bo uaod: it ____„___ f ctrlrrlr err,rhtr knc•.r.c,�_,__,____•____/i'a't Bed System Size: x Alternative System: �L / length andlor size d, HOLDING}TANK SYSTEM: (if required) Number of tanks: 1 Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency, ?. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON (please read) r°or your protoction, plonse rota flint pursunttt to Section 136-29 of tho Coda of ilia TOWtt.;>;, of Queotistiury, any portrtit of npprovnt ilrantcd which is bnsed upon or is gr:1/11ted'.J11 , rolinnce upon any n.ntotial misrepresentation or faihrro io make a tnatotial tact or U•43-..,., NR }�£' circtnnstattco kn6wr by or on behntrofar npplicaut, sluill bo void. n• :yr{tyy I linve rend the roguintions with tespoct to this npltlicntiott nrd ngroo to nbido by those nrd oil* roquiremonts oftho'l'own ofQueensbtiry Satiitnry Sewaf;e Disposal Ordinance, Signature f res albie person Date YOWN OF QUEEKSBURY - t ( BUXL-DXNG- &---CODE ENVORCEMEN-r 742 Bay R"z-14d Queen mst3pur-y MY X2a04 SEPTIC DISPOSAL SYSTEM INSPEC-rION N a m e u> Loca -tion Da-te P e r-rn I t SOIt_ TYPE: Sand- Loam-Clay- Rt_-SUI _tS of Per-COla-tion 'Tes -t- ( ifr' applicable ) Rate-Minute/Inch -TYPE OF SYSTEM= ABSORPIrYON FIEL-D: Total Length Length of each -t r-o n c h Depth of trenches Size of stone SEEPAGE Pr-rS : Number— S -fze -Ft- x _F_t Stone size PIPING: S i ze Type Bldg . to Tank Tank- -to Dist - Box Dist _ Box to Fitald/Pi -t openings Seale-d ? - Yes No Partial JLOCA_rrOIW,/SEPAR.A7FIOr4S : Foundation to Ta-nk feet Founda-tion to Absorption -feet Separation o-F Pits "Feet as per Plol�_ Plan Yes- No LOCATION OF SYSTEM ON PROPER circle OMQ Fr-on t -c-Rea- - LeftSide - Right; Side Middle Front - Middle Rea r- COMMEWTS z SYSTEM USE APPROVED y NO Ar-r-I 4d= V, J_ P EENS BURY - BUILDING- &--CODE ENFORCE74EMY 74Z Bay R",-a6 �gtt�eeras:�sury NY 12004 SEPTIC DISPOSAU SYS-FEM INSPECTION Name Q 0 �( � Location D a-t te a r-m 1 -SOIL- -"PE- San Loam-Cl ay- Resul -ts o-fCceir-coola-tion Tes-t- ( ! 'F applicable ) Rate--Minute/Inch TYPE OF SYS-rEM= ABSORP-rYON FIEILD :-.-I-ro-tal Length Length of each ho, Depth of -ti-e-n S Size F S-ton _X I e e SEEPA E PI iamb (__ t__ S -1 z e -f-t - x -F-t . S7tont--- PZPXNG: Size Type Bldg . 7t -lank Tank- -t Di s-t Box D ! s-t - So to Flold/p_ ' opens gs Seal od ? es No Partial I-OCA 1!?7 SEPARA-Ull1r: Foesa i n -to Ta-nk feet Fou da-ti n to Absoi-p -tion feet Se av-a -ti ran o-F P ! -ts -F e-e*t Co forms as per PI o-t Plan YlTt;� N o, t-0 A-Ul ON OF SYS7rIF_=M ON PROPER-Tt-_�� ( C - r-cl e- ,c' Fr- -ht. - (Rea - Le-Ft Side - Right Side Middle- Front - Middle Rea r- COMMENTS z k SYSTEM U5E APPROVED = YES NO Ar-r-I%rc--cf Sul _1 no t_,tf,7k TOWN OF QUEENSBURY BUIUDING- &--CODE ENFORCEMENT 742 Ba_y R"act MY :12004 (518) 761-82�545 SEPTIC DISPOSAL SYS-TEM INSPEC-rIOM A il Name- o - - f Da7to -t Soyu Fyp<sa7dPL-am-Cl a y- Rosul is o-F Po -col ant i ti n Tes-t- ( I V applicable ) R a - M i nu-te/In ch TYPE OF SYSTEM: ABSORPVY FXEL-D - To-tal Length Le_n9t:h o_F ech rench Depth OF -tro c es Size of, S-tone SEEPAGE PITS ff iamb e r-- Size t X -F-t Stone size PIPING : Type B 1 ct g . -t o 1a n k- Tank- to Dist _ Box Dis-t - Box to Field/Pi -t Openings Sealed? - Yes ci P a r-t 1 al L_OCA-FXOf4,/SEPARA-r1ONS : Found a-tion to Ta-nk -FeetFouncja-tion -to Absor-p -t-ion -F c--e--t S e.P a rat I on o-F Pi -ts -Feet Con-Fomns as per PI o-t Plan s No LOCA-UXOM OF SYSTEM ON PROPERT ( cir-cle- one ) Front - Pear - LeT-t Side Righ-t Side Middle- Front - Middle Reai- COMMEWTS SYSTEM USE APPROVED = YES A v-r-1 u t--cf_- — 6 D ��W @C ua�++t+�tnn• m+ +,wmanarw 9 ?114Y i � to �ttl st�� 3�,;°AILS} f. •'I" ��f. t,t JCf ' 't 'lips �J i� �jL i�,��j j,C ,r k lip n 1 Itr( a C •f � J , 1101 IAd»p......�,.._� 3LML&Iltfby�WYtkS4VCgC1]� �(\/�r��'ry Y . 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