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2000-013 M • C-erd,-ti' f , ian Town of Queensbury Waxen Cennty,New Fork Date January 24 r 2000 This is to certify that work requested to be clone as shown by Pennit No. has been completed, This structure may be used as a SEPTIC ' ALTERATION Location 47 BOULEVARD Owner.... ... ' ---r - '�A TAX MAP ' '112, -1-11- ° BY'Order Town Board. T F QUEENS a Director ofBuildinj &Code fbrcement BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury,NY 12804 i County of Warren (518)761-8256 VALUE $ 0 Building Permit No. 900 0_13 TAX MAP NO.. 112 . -1-11 Permission is hereby granted to JONE S, DAV I D A. Owner of property located at 47 BOULEVARD in the Town of Queensbury;to construct or place a SEPTIC ALTERATION at the above location in accordance to 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. Owner's Address: 41 BOULEVARD QUEENSBURY, NY , 12804 Contractor or Builder's Name: UTOPIA ENTERPRISES Contractor or Builder's Address: Electrical Inspection Agency: Type of Construction: SEPTIC, Plans and Specifications: SEPTIC. ALTERATION.. AS PER PLOT PLAN SPECIFICATIONS .', Proposed Use: SEPTIC ALTERATION $ 25 PERMIT FETE PAID-"I"PIIS PERMIT EXPIRES January 11 2002 (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'Town of Queensbury this 11- Day of January 2 0 0 0 SIGNED BYam. for the Town.of Queensbury e Enforcement Officer Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: Location of installation: I � Office Use Tax Map No. File Permit No.. //2 / � / // � Fee Paid ., Owners Name: �J'.4j >lor"I i Address: Z ,/I 2. INSTALLER'S NAME : dD�^G/ re�/��/S PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate #bedroom(s)and multiply ll of bedrooms with applicable gallons per bedroom to equal total dailyflow) Year of House: No of Bedrooms x Computation = Total Daily Flow 1980 or older '7 x 150 gal/bdnn = 1980—1991 x 130 gaUbdrni = 1991 —present x 110 gaUbdrm = Garbage Grinder Installed yes� / no � - r7��R%/ Spa or Whirlpool Installed yes_ / no 7 JAN 19 2000 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) TC141's, ri, ,'t."c:BURy BUILDING A CC3t�B Tppagraphy Soil Nature Ground Water Bedrock or Impervious Material Qomcstip Water Supply Flat sstsu,� at what depth at what depth munici olltng Ioa� feet S feet we 1 Steep slope c ay 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. G Septic Tank: �`� IZO n(min. size 1,000 gal.) Tile Field: each trench ft. Total System Length: 540 ft. Seepage Pit(s): number of_ N0-' size of each: ft by /1 Size of Stone to be used: ii /V rS / depth or thickness feet Bed System Size: ,IJ x Alternative System: length andlor 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. ,gignature of re 'onsible person Date 0 Q (D Q Q ab a -1 H c+ -4- M-J.(D (D W 4 (D 0 OJ o 0 y �� n a'0C C P) M W :1 0. '�Q h 1�N 70 :1 -0 h W H cf � 0 9 � p, ( (D c+ rr 4 coo O " U fi p '�'p (n 1 Q n Q pQ0 \ kti N too m . � a -n (D00 "jp. p y a a �, (+ a p r� rrTa ^� O 0 � � yZ (D a � �V *0 cn •aa t/9'� `�?5~I ► bit r 0CIN C� .+,fD rn00rt (n :3 M -aX C+ C the „ ;0 r � �° r � fi a 1 cn 0 770 a, � (D a Q U! a � ) Mr �' v a. 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REVIEWED 112.- 13 112.-1-9 1 r : : 112.-1-15.3 "1 have seen or observed, or believe I saw evidence of, all objects such as houses, wells,trees,fences,etc., shlown on this document. I also represent that I have pz,ss.,t,ally measured the distances set forth on the diagram." r DATE SCALE., One Inch Represents 50 Feet2000013 � E 2 . -1-11 JONES, DAVID A. 47 BOULEVARD JAN 11 2000 SEPTIC ALTERATION , . .•„ -- department 01i10(2000