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2002-1029 TOWN OF QUEENSBURY 742 Bay Road,Queensbuty,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OFCOMPLIANCE Permit Number:, P20021029 Date Issued: Wednesday,December 18,2002 _ This is_to.cerbify that work requested to be as shovm,b Pemut Number y P2002.1029 has been completed. Tax Map Number: 523400-301-017-0001-054-000-0000 Location: 28 JOHN St Owner: CHRISTOPHER&VTKI ANDERSON Applicant: IBS SEPTIC This structure may be occupied as a: By Otder of Town Board Septic Alteration Residential TOWN of QUEENSBURY ""o Direetor of Building&Code Enfoteement TOWN OF QUEENSBUR.Y 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes,.(518)761-8256 BUILDING PERMIT Permit Number: P20021029 Application Number: A20021029 Tax Map No 523400-301-017-0001-054=0.00-0000 Permission is hereby granted to: `-III SEPTIC, For property located at: 28' JOB St 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. Tie of Construction Value Owner Address: CHRISTOPHER&VIKI ANDERSO 28 JOHN St Septic Alteration Residential Total Value QUEENSBURY,NY "12804 Contractor or Builder's Name%Address Electrical Inspection Agency Plans&Specifications 2002-1029 Residential septic alteration per plot plan and specifications. $25.00 PERMIT TEE PAID-THIS PERMIT EXPIR-fiSiN, Wednesday;December 17,2003 (If a longer period is required,,an application for an extension must be made to tl}F'600,,d %Enforcement Officer of the Town of Queensbury before the expiration date.) , Dated at the Town of Queensbu ; T sd y;December 17,2002.µM SIGNED BY for the Town of iQueensbury. Director of Building& ode E_ orcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: ................ Office Use Location of installation: e- J-0 4-4,c File Permit No. Tax Map No. Owner's Name: 16t Fee Paid Address: .�e ............. 2. INSTALLER'S NAME 7 2oog PHPPWJ NO. IV OF 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) BURY bedrooms with applicable,gallons per bedroom to equal tota Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older x 150 gal/bdrm = d 1980- 1991 x 130 gal/bdrm = 1991 -present x 110 gal/bdrm Garbage Grinder Installed yes no- K" Spa or Hot Tub Installed yes_ no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) TavoeraDhv SoiM-"ature Ground Water Bedrock or Impervious Material D Water Sun-olv Flat sand at what depth a municipal---') o ing Z eet Steep slope clay if well; water supply %slope other from any septic-system depth: absorption is 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: 49 Od gallon (min. size-7,000 gal.) Tile Field: each trench 57d ft. Total System Length:;I>e Z> Seepage Pit(s): number of size of each: _ft. by_ft. Size 9f Stone to be used: # l depth or thickness feet 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 &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. ature of responsible.per—son Date +r•t . r s. .. al�ury Alypinitli X (; $ PIE I.A.) SPA"Alt.A'1`IL3N Itl�tZl:) ItI�[tilI:t�1'I`;i POND S' rs tt'.v.i . • •crt+stss cJ�$ertC; wr— �..• �•— ------------- -- ,tom f. _ l :=:xtWO.Iy..,, 7. SIGNt TUR E &INFOPMATIO7,`T FOR SPUr4;$ "r'rzx-.%A"%F&wA'-•.•.-.., ro +) 4J +) 0 0 l U 1 v � 0 v " N P ,� �� � Q w SLY 1 in � C v I w U c E z 1 w © v 'N 1 0 1 +�.0 �. W `r y a 'ry 0U x �'' Z V) v A.CL ?'0� �"� 0 ro " 4 \ , g s.4 0 `No as � Olt � 1 U r-, a a m1 ,0 0 41 � 4" 0 v -0� J �I CO LL Q) <a � �t9�� � WMUcv „ � 0 N � oz .aNW + vc � -40o� au) a • 0 ' " f � V) cccro v r � N d x ".. Q o o w W N fr. U) Q.(I. �? 4., w r , O n �r.r"r. � a a a 4-) a" ((S a"4 .c v W is "r9.M (0'�! (tl v Z u M � IC/�� c v4 v c0,1 G ro'y. ca� W W > ;. V V (Y I" �• W v1 {� �r w �I"" '�'a� U �: wZu �C V�D raw C 7 2002 BUS D N se s�� °b �t en or A� ��'�0,7 S s��'ft a s�j✓ rso�la// thts Qe�as h04, - y/T:•ac3 c(!,'tJ.o S�'S fvo �/��1iC� s � el'7t 17, etc of, URF tt�00 t,�a�� d a� TOWN OF qU EN IS ICY BUILDING ' B Il e 3 REVIEWED BY DATE - r p r AN < r