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2001-727 TOWN OF QUEENSBURY t4r0 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010727 Date Issued: Tuesday, October 02, 2001 This is to certify that work requested to be done as shown by Permit Number P20010727 has been completed. Tax Map Number: 523400-308-005-0001-029-000-0000 Location: 408 WEST MT. Rd Owner: SUSAN SHEERER Applicant: SUSAN SHEERER This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY (-7).2 .,P 4 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: P20010727 Application Number: A20010727 Tax Map No: 523400-308-005-0001-029-000-0000 Permission is hereby granted to: SUSAN SHEERER For property located at: 408 WEST MT. Rd 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: SUSAN SHEERER Septic Alteration Residential 408 WEST MT. Rd Total Value P.O. BOX 544 FORT EDWARD,NY 12828 Contractor or Builder's Name/ Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans &Specifications 2001-727 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, October 02,2002 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of ueensbury b ore the ex.i ati.n date.) Dated at tl(ee To n o e bu ; '1 es ay, October 02,2001 SIGNED BY *r ' _ for the Town of Queensbury. Director of Building&Code Enforcement ,„ . Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: ZU J� !�1./_ � Office Use Location of installation: a e` ° l File Permit No. 21)?17C)17 Tax Map No. / / 'c)Fee Paid C J, Owner's Name: fay) to/ /-el,-J Address: T o - Le s t /44'---- /wl , 2. INSTALLER'S NAME : N a0 %(...,,Lc, PHONE NO. 7?Z - 7)s 7 3. RESIDENCE INFORMATION: (circle ear of dwelling, indicate#bedroom() and multiply# of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow �1980 orroolder 2- x 150 gal/bdrm = ©� � t�� 198V • RE 0— 91 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = SEQ 7 2001 Y Garbage Grinder Installed yes / no2 TOWNII OF G AND CODE UR. Spa or Whirlpool Installed yes_ / no BUILDING AND CO 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) • T rah So' ure Ground Water Bedrock or Impervious Material Dater Supply san at what depth at what depth . ieipal Rolling oam feet feet well 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. Septic Tank:1 CC° gallon (min. size 1,000 gal) Tile Field: each trench C y ft. Total System Length: f91-C- - ft. Seepage Pit(s): number of /t size of each: ft. by ft. Size of Stone to be used: # Ai/� / 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 require the Town of Q sbury Sanita Sewage Disposal Ordinance. 01"---J , 026 6 ig ature of responsible person Da e TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 10'L304 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name BU iY\ 1 p Location o g rim-A; klki4_ Date \���`� " Permit # iO t' 7 --7 SOIL TYPE: Sane- oam-Clay- Results of '-rcol .tion Test- (if applicable) 'ate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: otal Le t1 / Length of each trench ' 1fL Depth of trenches 7,, Size of stone ;,,.-t i-T A-11* SEEPAGE PITS: mier- Size - - ' t. c ft. Stone size - k PIPING: Size Type Bldg. to Tank p` �� Tank to Dist. Box w Dist. Box to Field!' ; Yt �b� 3i Openings Sealed? No :Partial LOCATION/SEPARATION Foundation to Tank feet Foundation to Absorpti •n . feet . . Separation of Pits et Conforms as per Plot P an es No LOCATION OF SYSTEM ON 'ROPERT • (circle one) Front - Rear - Left Side - Right Ski de Middle Front - Middle Rea COMMENTS: • SYSTEM USE APPROVED: YES NO Arrived: Departed: �` . , Building Inspec or D 7a7 RECE VE* 1 SEP 2 7 2001 TOWN OF QUEENSBURY p BUILDING AND CODE "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells,trees, fences, etc., shown on this document. I also represent that I have person easured the distances set forth on the diagram." )D9 , , _. SIGNATURE DATE i A �7 f o v • o 0 A r w TOWN OF QUEEN`' URY BUILDING .71 , .PT. REVIEWED BY ` /' ����/r/��K� Ail ier i1/ DATE ' lytieJT il-.V