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2000-879 TOWN OF OUEENSBURY 742 Bav Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761=8256 CERTIFICATE OF COMPLIANCE Permit Number: P20000879 Date Issued: Thursday, November 16, 2000 This is to certify that work requested to be done as shown by Permit Number P20000879 has been completed. i Tax Ma Number: } r p 523400-114-000-0002-009-000-0000 Location: 104 DIXON Rd Owner: STEWART & PATRICIA GATES LE Applicant: STEWART & PATRICIA GATES LE This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building & Code Enforcement TOWN OF QUEENSBUR'Y 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000879 Application Number: A►20000879 Tax Nlap No: 523400-1 14-000-0002-009-000-0000 Permission is hereby granted to: STEWART & PATRICIA GATES LE For properly located at: 104 DIXON Rd in the ,l,otvn of Queensbuty, 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: STEWART & PATRICIA GATES LE Septic Alteration Residential L.,K.,S.,JR.& R. GATES Total value 104 DIXON Rd QUEENSBURY, NY 12804 Contractor or Builder's Natne / Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans & Specifications 2000-879 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATION $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES; Saturday, November 16, 2002 (Ifa longer period is required, an application for an extension must be trade to the code Enforcement officer of the Town of Queensbury before the expiration date.) Dated at the To r166ueensly6 ya Th d , November 16, 2000 SIGNED BY 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 IN FORMATION: ++ �`� ............................................ _- ..._............................._......................................... r'lof �L/ 1�c�^y. r (7ftice Use Location of installation: E File Permit No, i✓�,,��yy��,,,,J _ L�Q 7 1 Tax Map No. 1 1 ©fir —f� ! 1 /L' G % f - Fee Paid Owner's Name: .] f ............ -? Address: _ { / k r t -- 2. INSTALLER'S NAME : AIj I TtW PHONE N07 92� 7 ''� 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 4 bedroom(v) 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 or older x 150 gallbdrm = ` Ct 0 1980 — 1991 x 130 galfbdrm 1991 — present x 110 gal/bdrm = ti V E D Garbage Grinder Installed yes _ 1 no 140V 1 5 2000 Spa or Whirlpool Installed yes I no .,__ TOWN OF QUL. Fts,�t*URY 4. PARCEL INFORMATION_ (circle applicable information & indicate measurerasr LRiNG ANL. t OtDE T h Soil ature Ground Water Bedrock or ervio s Material Domestic Water Supply t d at what depth at what depth Rolling loam feet �,Tfeet well ,Steep slope clay if well; water supply �% slope other from any septic-system depth: absorption is fc, 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. (P L,4 ,,f'r. � ) Septic Tank: f12 G gar lllon (min. size I, 000 gal.) rP7 4, ;VZ Tile Field: each trench _ 7 �+ft Total System Length: Seepage Pit(s): number of 0''�A size ofeach. ft. by fl. Size of Stone to be used: # __,0V1A— f depth or thickness feet Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: I Size of each: gallons I 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 ra lations with respect to this application and agree to abide by these and all require of th Town of Queensbury Sanitary Sewage Disposal Ordinance. mature of respon ible Person ate TOWN OF QUEENSSURY BUILDING & CODE ENFORCEMENT 142 Say Read Queensbury NY _ 12804 (518) 761-8256 SEPTIC DISPOSAL SysTFqM INSPECTION Name �� i ocati on Date rmit #_, c � f`S 3 � SOIL TYP : Sand- m- Tay_ Results of Percol ati o Test- ( if applicable ) Rate- nutellnch TYPE OF IYSTEW ABSORPTIom FIELD : Tota Length Length of each trench `" - Depth of trenches Size of stonrd L- SEEPAGE PITS er- Size - . x ft . Stone size PIPING: Size ype Bldg . to Tan _ _ �`[ `L 'aCrTank to DistLt " 1Dist . Box tod! t ___— '-I- -` -Openings SeaYes No arts aLOCATION/SEP � feetFoundation kFoundation o Lion *2 feetSeparation _ feetConforms as of P11i,�an es NoLOCATIONI OFON 1 OPERTY: ( circle one ) Front - Rear - L ft Side Right Side Middle Fr - ddl ee Re air` ' -- COM*wNTS 4 L i 1 F SYSTEM USE APPROVED : YES Na Arri Ci D 7 ding I for c -V/7 }� d RECEIVED F9- NOV 1 5 2000TOWN OF QUEEiVSBURY BUILDING AND CODE I i r r ( R r E s M9V bserved, air believe l saw evidence of, s how, wells, trees. fences, etc., .TOWN OF QUEEN RY umeaL I also represent that t have 7�" dlstancas set forth on the diagram."BUILQ4NG & III "I h1# 4V EVIEWEU BY T -- ! DATE t]ATE _ 1 t'_._ } E'er-•l G— ,f Al C I