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2000-737
TOWN OF OUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20000737 Date Issued: Tuesday, September 26, 2000 This is to certify that work requested to be done as shown by Permit Number P20000737 has been completed. Tax Map Number. 523400-080=000-0001-025-OIO-OOOO Location. 13 HAVEN Ln Owner. BRIAN & SHELLEY CONLIN This structure may be used as a. Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY 1: JW d� Director of Building & Code Enforcement TOWN OF +QUEENSBURY Et 742 Bay Road, Queensbury, NY 12804-5902 (518) 761 -8201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000737 Application Number: A20000737 Tax Map No: 523400-080-000-0001 -025-010-0000 Permission is hereby granted. to: BRIAN & SHELLEY C©NLIN For property located at: 13 HAVEN Ln 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: BRIAN & SHELLEY CONLIN 13 HAVEN Ln Septic Alteration Residential QUEENSBURY, NY 12804 Total Value Contractor or Buiidci's Name / Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET QUEENSBURY, NY Plans & Specifications 2000-737 SEPTIC ALTERATION AS APPLICATION $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday, September 22, 2042 (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 f +Qu sb ; rid S er 22, 2000 SIGNED BY far the Town of Queensbury. Director of Building & Code Enforcement Application for Permit - Septic ©isposal System Town of Q"ueettsbury 742 Say Road Queensbury, NY 12804 (518) 761-82.56 1 . OWNER INFORMATION: _......._.........__...._......................................_..,.................,......,_...._..... Location of installation: fir: .. . t'�,+' i / D 'Ce _ � / �/ Tax Map No. / / File Permit N �o. ,�+' Owners Name: a) /` ,t ,/ C.C2 d Z fLL Fee Paid Address: 2. INSTALLER'S NAME PHONE NC7, 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply # of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No of BedKQgms x Computation — Total Daily Flow 1980 or older _ x 150 gal/bdrm 1980 - 1991 - x 130 gaVbdrm = 1991 - present x 110 gal/bdrm = - Garbage Grinder Installed yes / no Spa or Whirlpool Installed yes ___ / no _� 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) tu rep Ground Water k r Impervious Material D Water Seipp 1+lot an at w t depth a. mdcpth mrrrf ' frig am leer feet well Steep slope clay ff well; water supply �3o slope other from any septic-system depth' absorption is ft. Percolation Test: (To be completed by licensed professional engineer or archflec) other !date. . ZZq minute per inch 5. PROPOSED SYSTEM: Far blew Cunstru€tion: 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 sire of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: Z42cl gallon (min, size 11 000 gal.) Tile Field; each trench wed fi; Total System Length: Seepage Pit(s): number of size of each: ft by fl. Size of Stone to be used: # / depth or thickness Bed System. Size: x Alteniative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons / TOTAL Capacity: gallons Nate: Alarm. System and associated electrical work roust 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 f Queensbury Sanitary Sewage Disposal Ordinance. Roe 9 C::�; cx-> nature of responsible person Date ToWt OF 8i1IL0IN CODE QEENSSURY '742 ENFORCET AIV) ad Uueensbu y NYy 1 -- _r3! _I2804 (518) 761-8256 SEPTIC DISPOSAL. SYSTEM INSPECTION r Came Location Date ermi t SOIL Typ San seam-C l ay- Results of percolation Test ( i f aPPlicab' e ) Rate-Minute/Inch TYPE OF SYsTEIf ABSORPTION FIELD: Total Length Length 9 of each trench Depth of trenches j Size of stone - ---z�—� SEEPAGE PITS: Size - ft . r_ Stone s7ze'�-- ft . j PIPING: Bldg. to Tank Size Ype Tank to Dist . Bo �T�G Dist . BOX tC? Fie7 Pit :3 Openings Sealed? � ` LOCATIQy/SEPARATtpY o art 7 a Foundation to ank Foundation toA } � feet Separation of Pits � t � a Conforms as Z feet Per Plot plan eet LOCATION OF SYSTEM ON PR es No ( c1rC7e one ) . Front - Rear - Left s ;�ra r, . Middle Front -M7dd7e , g Side £BENTS: �-�� SYSTEM . USE APPROVED: ES O Arrived: DepartecC- �. C I have seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., TOWN OF QUEENS RY 5h;;wn on this document. I also represent that 1 have Personally asured the distances set forth can the diagram." Jzc� "O�& Y�C" ) 1�d o—A REVIEWED DY "1i3NA%rLJRE 77 DATE DATE e 1 Z00O 0 0 L rr cr p v S �-- Cs �-