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2000-907 TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761=8256 CERTIFICATE OF COMPLIANCE Permit Number: P20000907 Date Issued: Monday, December 04, 2000 This is to certify that work requested to be done as shown by Permit Number P20000907 has been completed. Tax Map Number: 523400-11740-001043-000-0000 Location. 18 WESTERN AVE. SOUTH Owner. GARRY LA MORA SR Applicant. GARRY LA MORA SR 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 +CLUEENSB►URY 742 Bay Road, Queensbuxy, NY 12804-5902 (518) 761-8201 Ct Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000907 Application Number. A20000907 Tax Map No: 523400-117-000-0010-003-000-0000 Permission is hereby granted to: GARRY LA MORA SR For property located at: 18 WESTERN AVE, SOUTH 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 Qonstruction Vaa Owner Address: GAR.RYY' LA MORA SR Septic Alteration Residential 19 LESTER Dr Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency Plans & Specifications BP 2000-907 SEPTIC ALTERATION; TWO BEDROOM HOUSE $25,00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday, November 28, 2002 (If a longer period is required, an application for an extension must be made to the code Enforcement Officer Dated at the To of I u ovember 28, 2000 SIGNED BY for the Town. of C2u.eensbury. 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 INFORMATION; _..............I...4 ,_........_................................ Office Use Location of installation: �y File Permit No. Tax Map No. f C ! Fee Paid zz*� Owner's Name: t�� 40q . . ......................._........._......................................... ...E Address: /��' u ' e- e� T �N ' 2. INSTALLER'S NAME : PHONE N 42000 V OF 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate it bedroom(s) and m Oi t JelyssuF4,1, bedrooms with applicable gallons per bedroom to equal total daily o Cpp Year of House: Ng of Bedrooms x Computation = Total Daily Flow 1980 or x 150 gaLbdrtn = 3ez) 1980 — 1991 x 130 gal/bdrm = 1991 - present x 110 gal/bdrm = Garbage Grander Installed yes 1 no s Spa or Whirlpool Installed yes 1 no 4. PARCEL INFORMATION: (circle applicable information &, indicate measurements) T�QpgggAphv SoilNature . r and Water Bedrock or Impervious Material t r Supply 141at San at what depth at what depth mrrnici al Rolling Caro 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 architect) Rate: minute per inch 5 . PROPOSED SYSTEM: For N Congrucfl n: An 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: leA Q P gallon ('min. size 1. 000 gal.) Tile Field: each trench ft. Total System Length.: ft. Seepage Pit(s): number of / size ofeach: r ft. by ft. t Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length an& or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: 1 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 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. Ngnat&lre of responsible person Date TONN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 1oad Queensbury MY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name d ` �r Location Date 1 v P erm iS. #�--r �— SOIL TYPE: San a- Loam- Cl a . Resul is of Perc�pl ati on T st- ( if applicable ) Rate-Min to/ Inch TYPE OF SYSTEM: ABSORPTION FIELD Total Lenqth Length of each t nch Depth of trenches Size of stone SEEPAGE PITS : !dumb r- f ------ Size - _ ft . Stone size _ Size ype � PIPING: Bldg . to Tank Tank to Dist . Box ----- Dist . Box to Field/Pits No art� a Openings Sealed? LOCATIONISEPARATIOMS : feet Foundation to Tank on feet Foundation to Absorp feet Separation of Pits s No Conforms as per Plot Plan LOCATION OF SYSTEM PROPERTY : ( circle one ) Front - hear - Left Side - Right S e Middle Front - Mid a Rear COMMENTS SYSTEM USE APPROVED : YES MO . Arrived: Departed: ::Dkf Building Inspector TOWN[ OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 say Road Queensbury NY 12804 (519) 761-8256 SEPTIC DISPOSAL TEM I PECTION Name Location 1 q Date 11 .3G► Permit # � �C3 SOIL TYPE?/ S n Loam- Clay Results o rcol ati on T st- ( if applicabl ) Rate-Mi ute/ Inch TYPE OF SYS ABSORPTION! FI yD: Tota Length Length of each trench Depth of trenc s Size of stone SEEPAGE PI mb Size - � � f Stone size PIPING : Size Ype Bldg . to Tank Tank to Dist . Bax Dist . Box to Fiel 1 Openings Sealed ? es No artsa LOCATION/SEPARA ON5 feet Foundation to T nk Foundation to A sorpt n feet feet Separation of ' ts Conforms as pe Plot P n e No LOCATION OF SY M ON P PER ( circle one ) Front - Rear - 'Left Side Right Side Middle Front - Middle Rea COMMENTS : ice P( C.- c'� Ur '�e'� '�' fiG'•'Lr� 4d SYSTEM USE APPROVED : YES NO d Departeeprarted Building Inspector ,09 •s- - Lii'ON N011035 9 0:n" rat aawrwn w, nr 1�IYAalO Y3iY/+91 I tMa,e ltai MI lYVY � iN A1N900 N3tltlYM 1�IYASIU 9NI1xD�='AYB60 153M.x�llY (L/) f`'. " 'oY 010x/ 1 Y Sit IOflgU rIYY it 1033a7 Y3eY lu= I� At1f1BSN33(10 d0 4001 • `110f � teal le)lvptl YOIO3w10 � � eN:m o1rC ;1 1Y1 )r d0 dvW Xvl ool IaI3C1 YOItYIwPo i �I- ''%� 3xAreemowA 1a1N1S10 191a3dS _ ON OV0 at 110Ito 3S �► � ( � . tl• nt e.'t at•., ZI'q't•'E'9-GII Z'62'ZI'6 031313021-t-LII su - 031313001-L-tll �_� 9. 0313130 ZI-£-LI I 0313130 9-2-LII tu. I. fS 9, I 1t1� A t0 + 3Gp a0 Ny7p�l—t- i su " i u1„ p•w n1r" f Il t.i ' ' -.. 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