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2000-351 • q C-eft, fiCate of. Complial"Ice Fawn of Oucensbury "Warren County,New York Nay 22t 2000 Date This is -o certify that work requested to be done as shown by Permit No. � has been competed, SEPTIC ALTERATION This structure may be used as a 382 LUZERNE RD, Location Owner NICHOLSON, RICHARD & KAY TAX AP NO. 121 . -4 .11 By Order Town Board (TO OF F R �J Director of Building&, Cade Enforcement BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury,NY 12804 County of Warren (518) 761-8256 VALUE $ 0 Building Permit No. 2000351 TAX MAP NO, 121-.-4-11 Permission is hereby granted to NICHOLSON, RICHARD & KAY Owner of property located at 382 LUZERNE RD. 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: 382 LUZERNE RD. QUEENSBURY, NY 12804 Contractor or Builder's Name: SMITH, FRED Contractor or Builder's Address: 23 VERMONT AVENUE QUEENSBURY, NY 12804 Electrical Inspection Agency: Type of Construction: SEPTIC Plans and Specifications: SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS Proposed Use: SEPTIC ALTERATION 25 May, 22 2002 $ PERMIT FEE PAID—TfIlS PERNIIT EXPIRES (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.) -. - 22 May 2000 ', Dated at the Town of Queensbury this - Day of SIGNED BY for the Town of Queensbury Code Enforcement Officer Application for Permit—Septic.Disposal.System -- Town of Queensburj 742 Bay Road Queenshury,NY.1280 t (518) 761-8256 1. OWNER INFORMATION_ ............... ..._......................... Office Use Location of installation: _ :A L File Pernnit-No Tax Map No. rV / I € Fee Paid �L, Owner's.Name- / }....... ...._............................ ..................._.....,._q.:...�............::........... ..__..__ Address: ✓+.U Z- Rd I V. . 2. INSTALLER'S NAME J /P�%'1'.. 5 ! L PHONE NO. WAY • zOOO fN ;ts r-ENS8LIRY.' . 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and mu�l L F1NL7 CO® bedrooms with applicable gallons per bedroom to equal iota Year of House: No of Bedrooms x Computation - Total Daily Flow. 1980 or older x 150 gaUbdrm = 0 O 1980- 1991 x . 130 gal/bdrm. _ 1991 -present x 110 gal/lidrm = Garbage.Grinder-Installed yes / no Spa or Whirlpool Installed yes / no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) TOIRo graph Soil Nature Ground Water Bedrock or Im ervious Material DpinestLc.Water Supply , Iflat san. at what depth at what,depth rmunieipal. o ing I oam feet feet we 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-architeco - 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 t' the size of the septic tank and leach.field for'each Garbage Grinder,Spa or Whirlpool Tub. Septic Tank: 4660 gallon(min; size I,000 gal.) Tile Field' each trench 5�/ f?.;. Total System Length: Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to-be used: # depth or thickness feet. Bed System Size: x Alternative System: length andlor.size 6. HOLDING TANK SYSTEM:_ (if required) Number of tanks: I.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 nbte that pursuant to Section 1.36-29 of the Code of the Town of Queensbiiry, any permit`or approval granted which is based upon or is:.grarited 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 wn of ensbury Sanitary Sewage Disposal Ordinance. Signature,.of responsible person / D to �.J V1, f (0 4 4J 0 4J 4-) (1 Q) 0) az S. 4A 4- 4- t/? z 4J W ; s CL >m W l � CA N% d ix 0 z � N W LP 4J .0 Q (U +) 4J U^ olJ or a) W ,C U � a a N � G,) tYf r-Wi I* f w U .�G , oz a 4`" ati� q. r o '� y 4W Off, N J-0x "No © 0 `o 0) 0 W u C. r I�i 0 tl- it- G V! �.,�,�r N A V1 it M H C� cnCLUB 04-W 0 4Jp4M -P -P +� � � r dIV o c ou l «gyp ^W cif 0 (d (o �'Mr. Nz uj a, ro N -Al :3 W0O)o0a. avc O)X � C< ccrd.4.+ r� Co W > � (A E U 4J M N4- LOZCINWNa1TJCN (DU � 3QC6- 0 ,0 v 'r M 0) t) 'r W Ir 4J N r• ro,� �' , ityPhy't. � p Gy '�;�s�a rn W4µ�� L ll( }' 'D 2. 2� MAY 2 2 2000 TOWN OF QUEENSSURY BUILDING AND CODE rn �P b• 421 p 'NTCHOL , .RRTCHARiI & AY SON ERNE mmr'" m a Z F"Ihave seen or observed,Qweftc� N chiects such.as houses,wefis,,hes juices etc m {' a a`ahis document, : sint,, . . �;f4`; °'' ent. I also represent that l',have ; t." o!easur, the di ances set'f _ Zt orth'on't dia am. U) Liu �l �Iq Uid #4010/ww