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2000-904
TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE %F COMPLIAN " Permit Number. P20000904 Date Issued: Wednesday, November 29, 200 This is to certify that work requested to be done as shown by Permit Number P20000904 has been completed. Tax Ma Number. � v p 52340U72- WO003-010-00NOW Location: 13 JUNE Dr Groner: MARK & DEBORAH TABOR This structure may be used as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY k7 Director of Building & Code Enforcement TOWN OF +QUE E NSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000904 Application NurJnber. A20000904 Tax Map No: 523400-072-000-0003-010-000-0000 Permission is hereby granted to: MARK & DEBORAH TABOR For property located at: 13 JLINE Dr 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: MARK & DEBORAH TABOR Septic Alteration Residential 13 JUNE Dr Total value QUEENSBURY, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency JAY SWEET NY Plans & Specifications BP 2000-904 SEPTIC ALTERATION FOR 2 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 he made to the code Enforcement Officer Dated at the Town bu T,,pes , vernber 28, 2000 SIGNED BY AI for the Town of Queensbusy: Director of Building & Cade Enforcement Application. for Permit — Septic Disposal Systems Town of Queensbury 942 Liny Road Queensbury, NY 128 �,�2Xlx 1 . OWNER INFORMATION; C +� �............ .....Otcc use •........... ...... . + �v . ... Location of installation: L �+ QUEEtySF,UR`r : Tax Map No f 3 f l b �f5SE3i CC?DE , Owner's Name: Vi. -4- � 1 , e. Fee Paid Address: - L{ l/l 4c 2. INSTALLER'S NAME : v� e a'�5 tr < ,r �] e t ey PHONE NO- 7f eZ:� X�` +T` A 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply # of bedrooms with applicable gallorzs per bedroom to equal total daily flow) Year of House: No. of Bedroonis x Computation = Total Daily Flow 1980 or older x VO };aifbdriai _ c2m 1980 — 1991 x 130 gaVbd rm = 1991 — present x I10ballbdrtn Garbage Grinder Installed yes / no,X Spa or Whirlpool Installed yes . I no fir' _ 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Suuuly at what depth at what depth munir 1 r .a tolling n feet ---feet well Steep slope clay ifwell; water supply _3o slope other from any septic-system depth. absorption is ft. other Percolation Test: (To be completed by licensed proftAssional engineer or architec) Rale: 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 lank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tanyk / zs e c�/ gallon (min. size 1, 000 gat.) Tile Field: each trench ft. Total System Length: fl. Seepage Pit(s): number of__r._ _ .size ofeach: --- it. byT f1. Size of Stonc to be used: 11 1 depth or thickness ,feet Bed System Size: x Alternative System: lit Ito 14 Yd S length and/or size f r 6. HOLDING TANK SYSTEM: (if required) Number of tanks: 1 Size of each : gallons l 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 ptirsuant 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. Slgnat re a, responsible person Date TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NAY 12804 Ol$) 761-825e SEPTIC DISPOSAL SYSTEM INSPECTION Namepj�_ - Location �r Date Permit #,Z y SOIL TYPE: San lay" s Results of Percolation Test~ ( if applicable ) Rate- Minute/I ch. TYPE OF SYSTEM: -t- ABSORPTION FIELD : Total Len h M7A a Length of each trench ' Depth of trenches Size of stone SEEPAGE PITS : Number- Size - fte , x ft . Stone size PIPING : Si zee Bldg . , Bldg . to Tank Tank to Dist . Box Dist . Sox to Field/Pi Openings Sealed ? Varti al LOCATION/SEPARATION . Foundation to Tank feet Foundation to Abs ti on _ feet Separation of Pi feet Conforms as per lot Plan s o LOCATION OF SYS ON PROP4%T ( circle one ) Front - Rear - Left Side - R • ght Side Middle Front a ear COMMENTS : SYSTEM USE APPROVED : YES !�O Arrived : DepartPIZ! . f T�F 7 Buy 1 ding p ctor x a` _ + WED � NOV 2 7 2000 c� orQwfv� ON QUEENSBl1f�1� � 0 1 g�G'�AN�D cC7[3E C { ¢l4VJ/ TQWN OF t�U Bl.:1R�'' � s a { h N BUILDING APT. I REVIEWS© B 5 DATE l I E1 "1 have seen or observed, or believe 1 saw evidence of, all obiects such as Douses, wells, trees, fences, etc., shown on this document. 1 also res se en Or on the diagram." personally measured the r eprest that I have C -L - d / DATE f �{ SIG TUR'E k I 1 VIC) l