Loading...
2000-142 C-ertifi "*tate of Com"Pliance Town of Queensbury Warren County,New York April 5 , 2000 Date '�� 2000142 This is to cNAifythore requested to be done as shown by Permit No. has been completed, SEPTIC ALTERATION This stmeture may be used as a Location Owner ONEN r KENNETH & JOAN TAX. MAP NO, 65ob2-2A7 By Order Town Board TOWN'F QUEBNSBURY ' cto'o But 4&Code Enforcement BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury,NY 12804 County of Warren (518)761-8256 VALUE $ 0 Building Permit No. 2000142 TAX MAP NO. 65 . -2-2 . 7 Permission is hereby granted to KONEN, KENNETH& JOIN Owner of property located at 21 EDGEWOOD DR , in the Town of Queensbury,to construct or place a , A I at the above location in accordance to application together with jfo-fplWs- Mifi6r1iT(ormation hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Owner's Address: 21 EDGEWOOD DR. QUEENSBURY NY 12804 Contractor or Builder's Name: IBS SEPTIC Contractor or Builder's Address:* IVAN BELL 2 LOWER WARREN STREET QUEENSBURY, NEW YORK 12804 Electrical Inspection Agency: Type of Construction: SEPTIC Plans and Specifications: SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS Proposed Use: SEPTIC ALTERATION $ 2-TERMIT FEE PAID-THIS PERMIT EMPIRES March 30 -----LO-O 2 (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 eensbury this 30 Day of Mnrr-b SIGNED BY Town of Queensbury Code Enforcement Officer Application for Permit—Septic Disposal System Town of QueensbIlly 742 Bay Road Queensbilly, Nl- 12804 (518) 761-8256 1. OWNER INFORMATION: ..............I............................................................­............................................. Location of installation: tl'tle- I Office Use T,- Tax Map No. File Permit No. Owner's Name: A—CIVA,11Z � Fee Paid Address: 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate ff bedroom(y)and multiply bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: Na. of Bedrooms x Computation Total Daily Flow 1980 or older x * 150 gal/bdriii 1980- 1991 x 130 gal/bdrin 1991 —present x 110 gal/bdrin Garbage Grinder Installed yes_ no Spa or Whirlpool Installed yes no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) QUQ9E P T a 11 Soil ure ure Ground Water Bedrock or Impervious Material Do u l Water S ppy mp W -and at what depth at what depth nrunicipat ing earn -feet —feet Steep slope clay if well; water supply slope other from any septic-system depth: absotplion is_J1. other Percolation Te o be completed by licensed professional engineer or architect) Rate: urinate Per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or arcliftca(unless installed in a Planning Board approved subdivision). Add 250 gallons to ille size of the septic tank and leach"Geld for each Garbage Grinder,Spa or Whirlpool Tub. Septic Tank:- /62 0 o gallon (min. size 1,000 gal.) Tile Field: each trench—Yd ft. Total System Length: a00 it. Seepage Pit(s): number of size of each: _ft. by Size of Stone to be used: 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. Signature of responsible person Date ` d 'I~? 'N 4J 0� 0 W 1-I 4J 0 00 0 "r I. f� V) 0 4� 01 C r W > v 0 H I 0 -P 0 � M O �I � +� z �- C C 0 c ra a� 0 u L or. WWI I 0 I 4JS S. 4 N (U, W 41 'r- N 0 U.- 41 Ll. a O W � � � a (0 4-) 4 N C \ s. 0 WO O'Qro �, 0 roro E ro 00 J J +• r M C 04JIW Q) C91 . u 0 p0) 00 a *r� F� (too 1 A' 0 � U e-, II 'j ` z W 'r- V � dV C IL a) MW .0 U U- 0 I` C 0 S N r-W H U C I .aG r 0' 0 4-, p.O im { C 0 r004 0 • ^ 1.1 0 rot�o,Y 0 , 04N 0W w conyW. 16 � � V M�) � y `T� V M 47 �"' or. �/! Y/ 0 'r- 0 4- O Q N C X 0 0 © 0 z H 0 4. -r-' 0 0 0 si- or.. Mr H in r I.W 04•W F; 4J 0M 0 � 4J � 0 *r 4J 0.0 0. -C 00 t 0 +J CH 0 010 r m 1% �p S 4 z I t"r *0 "0 S. 0 ► Z WO0)4JUQ. 01C* 0).\44-) C CCro4- M �w W U V !� 04- LO C C. NW N OLD C Ir OU Z:3 aC }r. 0, t�'1 Soo 0 ro 0 Q) "r, > 0 Q) 41"r-W -r ro 0 4JHry "r CIO 0 0 00 U z aacncncnc)i%aF- 0001LLLLV) u V In o ' have seen or observed, or believe l saw evidence of, all-objects-such as houses,wells, trees,'fences, etc., shown on this document. I-also represent that I have personally a ured-the dis antes set forth on the diagram:" \ �\'obo d T� £R " ` a `� SIGNA UR = DATE ULUNG %Y+•, "`y ,.w t,• PT. _ = REVIEW B ®ATE _ r �- _r_.�_...... -r �r t NC t✓ , o vC 1 l I O ( h To 0 Ne w G o o J r1P' 4 AUn1n o qO �+'�pl �dQZ 0 ddb' �_