2000-410 ` , F.�, ,l,y ,+� r r�nM i ,rt "'r'1�j "i.,i. p. •w31'n..r ha
14 h.. ""t°"� St t• ��� ( 1
i
'ert icate f
ompiance
TowAofQueensbury
Wren' County,New York
June j,3, '2000
Date
,
This is to certify that work requested to be done as shown by Permit INo,
has been completed,
SEPTIC ALTERATION
This structure maybe used:as a
504 SHERAN AVE',
Location
Owner CARDINALE, JOSEFN
TAX MAP NO, 1 2 0 o "'L-5 B Order Town BoardY
OF
Director of Building&d9tnforcement
t
BUILDING PERMIT
Town of Queensbury,742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
VALUE $ 0 200010
TAX MAP NO. 12 0 . -2-5 Building Permit No.
CARDINALE, JOSEPH
Permission is Hereby granted to
504 SHERMAN AVE.
Owner of property located at
SEPTIC ALTERATION
in the Town of Queensbury,to construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and m compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
500wjTdCX-V,Q(J t;s:AVE.
QUEENSBURY, NY 12804
COvC'acjEy1ori'$uilder's Name:
Contractor or Builder's Address:
12801
Electrical Inspection Agency:
Type of Construction: SEPTIC
SEPl�U dAET K4Tn5-N AS PER PLOT PLAN SPECIFICATIONS
SEA oc.!e y� fERATION
25 June 13 2002
$ PERMIT FEE PAID—THIS PERMIT EMPIRES
(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 ex*jMonLine ate.) 2000
Dated at the To In of Queensbury this Day of
SIGNED BY �~ for the Tows of Queensbury
Code Enforceme t Officer
APPlication.for Permit-'.Septic Disposal System.:
Town-ofQueeltsbutj? 742Bayltciarf-Queerisbury,NY ]2804 (5 IS)',7614236
I OWNER INFORMATION.". .............................:.........: _....... _.
Location ofinstalla' on: . LS U /J.�7r�!';fy/lf,1 �•
.... ..... .....
oinit use
Tax Map No. t / File:Permit No
J r Fee'Paid .- .
Owner's Name
Addressc
2. . INSTALLER'S NAME l/ PHONE NO. le
3. , RESIDENCEINFORMATK7N: (circle yea2r of dwelling,.indicate..#bedroom(s) and multiply# of
bedroo»rs.-with applieabl a gallons per,bedroom to-equal,total daily flow)
`Year of House: No of Bedrooms x C gm' utation- = Total Daily Flow
1980 or older ' x X, 150,gal/bdrm '
1980 1091 - x 130 gaUbdrm
1991 -present x 1 IO gal/bdrm JUN 1- 3 200 '
Garbage Grinder In`stalled F`�� ()F QUEC-NSSLj,'_
g yes` / no ./ 13UII- ING
Spa or Whirlpool Installed yes_ /- no. Aiiit�C(ltz
4. -PARCEL INFORMATION: (circle'applicable'information &indicate measurements)
T rSoil Naturbr and Water .Bedrock or Im p ervio s Material_ Do tic Water Supbiv
sand at w at.depth, at what depth rriunic
oiling oam feet feet well
Yteep-slope clay - ifwetl; water,supply
%-slope other _ from any septic-system
depth absorption is
other
Percolation Test: . (To be completed by licensed professional,eyrgineer 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 Gfi der;Spa or Whirlpool Tub:
Septic Tank:: apg'a71o'n'(min:size 1;!?QOgal)'.
Tile Field each trench 1�1 'f? Total System Length: 1�(Q ft:, 1 N31=
Seepage Pit(s): number of size pfeach: fT by ft
Size of Stone to be used:: fi / depth or thickness .: feet
Bed System Size: z
• Alternative System: Lz l length,.and/or size
6. HOLDING TANK SYSTEM: -(if required),
Numberoftanks:` / Sizeof each: gallons,/.TOTAL Capacity: - gallons
'Nate:, Alarm System and associated electrical work must be.inspected by a Town approved
electrical inspection agency.
7... ` SIGNATi1RE.,&INFORMATION FO,RRESPONSIBLE PERSON(please read) .
For your protection,please-note that pursuant.to Section:I36-29.of the Code if the-T own
-
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-
Circurrstance known by or on behalf of an applicant,ihail be void.
I have read the regulations with respect to this application and agree to abide'by these and all
requirement&of the Town of Queensbury Sat ' ry. ewage Disposal Ordinance.
2_�
-Vrgna , ,of respon l pe son - Dwe
TOWN OF QUEENSBURY _ f
BUXUDIN+IC $ CODE ENFORCEMENY
^'74_: i ' Bay Ro aCt
Qu�er�sbory NY XZB 4
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
L o c a t-i o n ' � "t'
D a -t aSOIL -rYYeE.:_ Sand-- o am- C-' a y-- _
Resul is of Per-col at-1 o Test-
( 1 -F applicable ) Rat - MI to/ Inch
TYPE OF SYSTEM-
ABSORPTION FIELD : otal Le gth _
.Length o-f each tre ch
Depth of —trenches s Size of st -ne -
SEEPAGE PIT _ N um e,:^--
Size - -Ft_
Stone size
PIPING Si ze Typo
B l d g . -to Tank
Tanis to Di st _ Sox
Dist— Sox to Field/P " -t
Openings Sealed ? es No . Payta a►l • c �a
LOCA-r10H 'SEPARATYOHS
Founda-t-i on to Tank _ -Peet
Foundation t o `Ab sorya -t-i on
Separation of— Pi -ts -Pee-t
Con-forsns as per PI of _ Zan e
'R.. OCATION OF - SYSTEM ON PROP
( ci rcl a one )
Front - Rear - Le-Pt - ht Side
Middle Front -- dl a Reax-
COMMENTS
SYSTEM . USE APPROVED= ..............
Arri
B cat d-i "fj 1eG tt�r
�t
have seen or
"I FC
observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences etc, JUN 13 2000
shown on this document.I also �,epreseut that I have TOWN OP QUEENSDURY
p orally measured the ''to a et th o, the diagram," EU...,ILDiNG AND CODE
NA RE. DATE T .--.
OWN OF QUEENS
Y
REVIEWED BY
DATE
lot•
41
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