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2000-862 1E 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: P20000862 Date Issued: Monday, November 20, 2000 This is to certify that work requested to be done as shown by Permit Number P20000862 has been completed. Tax Ma Number. 113 '1 � 5 p 400- 123-fl00-0{}01-0084a2-00f?0 Location: 589 WEST MT. Rd Owner: ANTHONY & KARI SIGNORELLI Applicant: ANTHONY & KARI SIGNORELLI This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY ( )J4 4 t Director of Building & Code Enforcement TOWN OF [QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-5201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000862 Application Nurnber: A20000862 Tax Map No: 5 2 3400- 1 2 3-000-000 1 -{008-002-0000 Permission is hereby granted to: ANTHONY & KARI SIGNORELLI For property located at: 589 WEST MT. Rd 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: ANTHONY & KARI SIGNORELLI Septic Alteration Residential 589 WEST MT, Rd Total value QUEENSBURY, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency SIGNORELLI & SON 589 WEST MOUNTAIN ROAD OUEENSBURY, NY Plans & Specifications 20a00-862 SEPTIC ALTERATION AS PER,. PLOT SPECIFICATIONS $25.00 PI�RMIT FEE PAID - THIS PERMIT EXPIRES: Friday, November 15, 2002 (ifa 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 ertsb ; Wed a da , November 15, 2000 SIGNEn BY /� for the Town of Queensbury. Director of Building & CVde E06rcement Application for Permit - Septic Disposal System Town o,f Queensbury 742 Bay Road queensbury, NY 12804 (518) 761-8256 1 . OWNER INFORMATION: Location of installation: , `� zz,. "S wee Use File Pormit No. 00 " �, Tax Map No. �./�' ! 6' Owner's Name: .rr`/.c / ,Ki �'. iidr� E ...._.. ......................_............................................ Address: `�' ! /psi /�fuv � ,!'. N41I 1 3 2000 /� TOWN OF SU OUEENS �, 2. INSTALLER'S NAME : �/` /�!'� f ry Q z�<C ' -�tNG It=e,fQ �qN6. �_...__..—a 14<ee 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 BedrLa�o`ms x Computa(ion - Total Daily Flow 1980 or older / x 150 gal/bdrm = RECEIVED 1980 - 199I x 130 gaUbdrm = 1991 - present x 110 gallbdrm = V 13 2000 UEEGarbage Grinder Installed yes _ I no ` TOWN OF G BUILDING I+�ID AND CC70EDE v" Spa or Whirlpool Installed yes _ _ _ f no 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) sQjLuaturo Ground Water Bedrock r IMecmigugs Material Domestic Water Suppi J� sa at what depth at what depth rif pal Rolling loam feet feet Steep slope clay ll; water supply % slope other any septic-system depth: orption is other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Constructi{ea: 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. Septic Tank: !c`� gallon (min. size 1, OY3f1 gal) Tile Field: each trench Total System Length: 4;9 -5 }1. Seepage Pit(s): number of /J size ofeach: ft by ft. Size of Stone to be used: # c / depth or thickness feet Bed System Size: x Ahemative System: length and/or size 64 . HOLDING TANK SYSTEM: (if required) Number of tanks: 1 Size of each: gallons I TOTAL Capacity; ,gallons Note: Alarm System and associated electrical work must be inspected by a Torun 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. S natu of o"i le person Date TOWN OF QUEEKSBURY BUILDING _ & CODE ENFORCE14MT 742 BaY Road QueensburY .-Y_ 12804 - (5is) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name r Location Date P { � s"� c PeZ SOIL TYPE: Sand- LoamResultsl °[able3QRat( if appTYPE OF SYSTEMI_ABSORPTION FIELD : TLength of each tren Depth of trenches Size of stone SEEPAGE PITS : Numlh r" ft . Size - ft . x Stone size Size — yp e PIPING: Bldg . to Tank — ------ Tank, to Di st . x Dist . Box to F eld/Pit Openings Seal d ? Yes No arts al LOCATION/SEP TIONS : feet Foundation t Tank ti on --- -- feet Foundation Absorption feet Separation f Pits ---Tes No Conforms a per plot Plan LOCATION O SYSTEM ON PROPERTY : ( circle on ) Front - R ar - Left Side - Right Side Middle Fr nt - Middle Rear COMMENTS " .R L SYSTEM USE APPROVED : YES NO Arrived : 00 Departed : Building nspec or pry or TOYil1 OF QUEENSBURY BujLUING.& QOD � ENFORCEMENT 74-2 Bay Queensbury NY 12804 (518? 761-19"6 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location Date ,; it..,�. SOIL TYPE : and oam-Clay- Results of Percolation net ( if applicable) Rate TYPE OF SYSTEM: ABSORPTaONeachL�rench Total k thY' Length Depth of trench s Size of stone um er SEEPAGE PITS : ft . x ft . Size - Stone size ize e PIPING: j 0:i Bldg . to Tank - � Tank to Dist . Box Dist . Box to Field P ' e o la art Openings Sealed? LOCATION/SEPARATI - eet Foundation to Ta feet tion Foundation to Ab orP feet Separation of Pi s e No Conforms as per Plot Plan LOCATION OF SYS SNi . PROP'ER ( circle one) ht Side Front - 'Rear - eft Side . .. � 9 Middle Front COMMENTS: + 1 t SYSTEM USE APPROVED * YES NO Arrived; Departed: dd - Building Inspec or tll���.-__-- 7" " Ufa✓�f','��� l�-I�I ' ' J..,.._-- - w.._.._..._______.—__..._.�..���4'�� � {J/u� ��t � � �� �� y��� have seen or observed, or believe l saw evidence of all objects such as houses, welts, trees, fences, etc. shown t,�is cc neat. ( also reoresen that l have v. ., tIi �I1 . iC Cic�idllT. � Of � 5I AiURE DATE � t G � © ' � i Q v 0 m Qm Cm Q. CD m m e �n TOWN OF QUEEN RY L BUILDING D REVIEWED BY DATE