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2002-936 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes '111, 761-1250 BUILDING PERMITI Permit Number: P20020936 Application Number: A20020936 Tax Map No: 523400-2196-009-0001-046-000-0000 Permission is hereby granted to: IBS SFPTIC &DRAIN For property located at: 19 TWICWOOD Ln in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and ot Iher 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: WILLIAM&ANGELA MOORE Septic Alteration Residential 19 TWICWOOD Ln Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency IBS SFPTIC & DRAIN ATTN: IVAN BELL 2 T,OWFR WARREN St 01JEENSBURY.NY 12904 Plans&Specifications 2002-936 Residential septic alteration per plot plan and specifications. A $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: IThursday,November 13,2003 (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 T November 13,2002 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 1280.4 (518) 761 8216 1. 0)V-TMR INFORMATION: ................. .............­........... ................... Office Use Location of installation: File Permit No Tax Map No. Fee Paid Owner's Name: z-1, .......... .......................... ............................. Address: 46 Z 2. INSTALLER'S NAME PHONE 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedr!oom(s) and multiply#of I bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation - Total Dail Flow 1980 or older x 150 gal/bdrm = ell, C9 0. 1 1980- 1991 x 130 gal/bdrm. = 1991 -present x 110 gal/bdrm. = -RECEIVED Garbage Grinder Installed yes— no NOV 0 7 2002 Spa or Hot Tub Installed yes— no TOWN OF QUEENSBURY 4.' PARCEL INFORMATION: (circle applicable information&indicate measurements) BUILDING AND Cobt T�wQgrayhy Soil:Nature Ground Water Bedrock or impervious Material ater Supply lqo 'sand at what depth at what depth a -municipall ing aIn t 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. 1�1 - <' ka Septic Tank: Let ( e�galn(min. size 1,000 gal.) Tile Field: each trench_ft. Total System Length: ft- Seepage Pit(s): number of. size of each: fi t. by fi- Size of Stone to be used: # t depth or thickness feet Bed System Size: X Alternative System: ALI, length andlor size LJ - 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 &U14FORMATION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section il 3 6-29 of the --Ode 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[ 81§'nature of resp&nsibFe-p rson I Date' I ' `Tt)4V11 .Uf '{2ti4't`11;4i)tit'x` - Sewers :t)ul ScwsiJ.r_ Disj)t)r::ti tits:)j){i:• AI)pinitii x t: i SP: IARA'i'ION REtZi.?itLI POND � 1nl�Ls.. i.s )rp.rn•rt- -• ''��...,.' 'rs i�'.4.� . _ IbusE G t) / '•Nam,. ._ , in:.ss�cs.:�rn.•,t t�1tYrr�ssres�) Z. SIGNATURE- $Z LNFORIviATIf�I'�TFS2kt IYi71Virss. r> ati.�•,i�v, a •••.•,:, 10 ©0 00 tiCChfD0ZCL10N�mN,b � � ��tV0 0 1 � � a � (D p) aN:3 m0 rE "� ! 0 to ti 4 H 10 0 0 0 N 0 /(D :3 00 1 c ,y �,. �.� 0 H ct r� C �1 h� � to {�,� ''�� �11J t 1" � � ..J O � � I A„` ,i ( (► � 0 C+ r+ Al 0 CM z y fD 01 0. 0© � 0 �' (D Al 0 �' I v ��c Mo �a o 0 CL cD tD m -j, gad � — h ! o� c� as p. — zv ' uj; - - i — ui U-Z Op `lSN CD- IA�,N- F UG 3 ao has say 1 a B ey T� .SIG e s �-pens- � � saa a' sheu ttir�atsp. rr Alle ua aea -`sII�M as � l� o Mo 1 Ana es I a� r °y e inns s - - a o- _ _ a — Js�ne —