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2002-809 li,l�1 TOWN OF QUEENSBURY 742 Bay Road,Queensbury NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFIrAT E F COMPLIANCE Permit Number: P20020809 Date Issued: Wednesday, September 25,2002 1 . This is to certify that work requested to be done as shown by Permit Number P20020809 has been completed. Tax Map Number: 523400-278.020-0001.012-000-0000 Location: 20 OLD BAY Rd Owner: THOMAS&SUZANNE NEWTON, Applicant: THOMAS&SUZANNE NEWTON This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement Application for Permit—Septic Disposal System - " S E i' f 2002 Torun of Queensbury 742 Bay Road_Queensbury,NY 12804 (518) 761-8256 L .OWNER INFORMATION: F":.t�!t '.e+ } - .i r' ................._................_..._ ix y f Office Use Location of installation: / i J ,1 62, �-�q Tax Ma No Q�'2� / 2" File Permit No. !�y p Fes Paid 2�_.-''- Owner's Name: 7'6 'i,�I SG e' Address: e x RJ� 2. INSTALLER'S NAME o�tGc�c�ec ,TT'ce� PHONE NO. 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 Comgutation Total Daily Flow 19 r older x _ 150 gal/bdrm = � 1980- 1991 x 130 gal/bdrm = 1941--present x 110 gal/bdrm = Garbage Grinder Installed yes_ ! no Spa or Whirlpool Installed yes 1 no 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) Too Soil Nature Gr 7Water Bedrock or I ervi s Material Domestic Water1 Fl san at what depth at what depth municipal Rollin Zoam "AAf feet L.f feet we 1 Steep slope clay ifwell; 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 Ngw Cons 49a: All individual sewage disposal systems must be_designedby 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: gallon(min. size 1,000 gal; Tile Field: each trench c! ft Total System Length: 2IS0 f? Seepage Pit(s): number of size ofeach: ft. by ft. Size of Stone to be used: #T _ — I depth or thickness_ ,Beet Bed System Size: x 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 &c 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 Sewers .xttti :ewilpe I)istit>sal (:Impter Azr mittli x t: �I;P�1ItAr1'IL3IN ItI;tZ>1I ItI:[1I1�:N'1`S 1. ' 1 �, Y'��LL 1�2 1/¢Trt•t'�- �. J,"' \_„%'�Nft tc l" fir J. 1bu xE G t1E , tip'�c��" it G . E 1 � f� O• n ` . rxY.xrst�'txa i A _........ 7. SIGNATURB 8, II FORMATION FOkt kLL:aYC7N�ifisi.�rr>1��:. �..�.�,•......i., N o r z o � 000*0 . a -� � � �� M i.cD (D0 a, o p a o a A-h.a :1 :3 >:3 r+ 770 H :3 m '0(D (+(0 c a r� p r+ r� r+ w q r� v, m 0 0 � p C l' p 0 p \ X CJ N st L4 -h L4 0 C 0 (D :3 Q a :3 :1 :3 0 (A (D H c+ c� Wo Ma01i0 ., °0 0 y��► s 0 a ��0`� z � � E ,�o so ro � nH -� 00) I N 3-C+\ I 2;c; M, 04 -is ox ro x � N , m� i :r r+ M v ro 0. (D (D N r b (D 0 c0+ rp+ cph a (D a 4- 4- 4- U} Imlla h h � ugo 4m) Q! 0 r- Uj w 'W N to N z u '� M 1 U1 4N QJ r I w vm1wro� 0 2 ' ro � c ro a} v 4J w r. r '�, r V � � y"� u c m �, ,0 as .0 0 1 0 I .0 S. ,�} „ ,N Q ,� 0 E '�- v 0 U 0 X 0. � Q} �� � ? 0 ro ro v ro a w 6Lv, �I � 1 0 � +� N 0 � Xrr. FI C 0 �aW C i Ql W ,C U LL 0 QJ}s 1 'r ON ro C � C -P 0 ro44J +J 0 � 5IL 014� . � ,} (h fror (nUw1CCCro�" Q1ctl � �w t� w 0'r�!Oi � 4� v1 �. N 0 W Lq..I C r- H 0 4- 'r. 0 0 Vl hallti �,�, � 0 t S. 1 0 O.�. h 04-w ,. w w ro ro 0 .�. 0 warn 4J vavcHMX41 otccro'4- $. C `0 h e�. ro 0 0 0 Qf r Q4 N (U 'r W 'r M S C�v? 0 fJ 0 Q �� 'r 0 1 ror. 0.00000GUS. r-( z -j a � tL� ��Q (/� V1G1V� A. QC1I-� © QdlI.�. t!. f� Ua+�t!. >. � 0 V) RCE j �`� SEP 2 � 2002 TOWN OF QUEENSBURY BUILMIG AN, ....... ....................... 17/7 b7 W . C� ments shall om n,,It rj�jfue%i as indicating the ld specifications are in full jjApli@nc8 Oth the code. O TOM, - L, URY REVIEWED B'v Z DATE ,