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1999-772 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY_ WARREN COUNTY, NEW YORK Date December 23 - 19 99 99772 This is to certify that work requested to be done as shown by Permit No. has been completed: SEPTIC ALTERATION . This structure ay. be used..as 2 'a 7 0 MEAL . h00h Location _ _ S35C.Ce dV r'a f U E L"L'i' E]. - t u CJ 371.1,7 Owner TAX MAP NO. 46. -2-38 By Order of Town Board • TOWN OF QUEENSBURY Director of Building & Code Enforcement BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury,NY 12804 County of Warren (518) 761-8256 VALUE $ 0 Building Permit No. 9 9 7 7 2 TAX MAP NO. 46 . -2-38 Permission is hereby granted to GREENE, JEFFREY & SUSAN Owner of property located at 2 7 Pl MEAnnWBB OM< B D in the Town of Queensbury,to construct or place a SEPTIC ALTERATION. at the above location in accordance to 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. Owner's Address: 270 MEADOWBROOK RD. QUEENSBURY, NY 12804 Contractor or Builder's Name: • - SMITH, FRED Contractor or Builder's Address: 23 VERMONT AVENUE QUEENSBURY, NY 12804 Electrical Inspection Agency: Type of Construction: SEPTIC Plans and Specifications: SEPTIC ALTERATION AS. PER PLOT PLAN SPECIFICATIONS Proposed Use: SEPTIC ALTERATION $ 2 5 PERMIT FEE PAID—THIS PERMIT EXPIRES December 21 2001 (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 of Queensbury this 21 Day of December 1999 SIGNED BY ` Z for the Town of Queensbury • Code Enforcement Officer Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use Location of installation: 276' File Permit No. \ Tax Map No. — Owner's Name: • Fee Paid �5, O Address: £7" Ad°JoG_),i6 eOt3,t' ,QI 2." INSTALLER'S NAME : Sr/ PHONE NO. 9'cF/ e% 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 Bedrooms x Computation = Total Daily Flow . 1980 o • 3 x 150 gal/bdrm = 4'50 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes— / no Spa or Whirlpool Installed yes / no Q( ©E C 2 u 1999 TO lr':',2 0:'l�:�ii„�;!v=•LURy 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) BUILDING AN CODF Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply (I'1at "~\ and at what depth at what depth •' ipal rSllipgam feet feet Steep slope clay I well; water supply _%slope other from any septic-system depth: absorption is /3 a i. 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. e"X'/s 77/U Septic Tank: ci gallon(min. size 1,000 gal) Tile Field: each trench 50 ft. Total System Length: GY 6 ) ft. Seepage Pit(s): number of size of each: ft by ft. Size of Stone to be used: # / depth or thickness feet Bed System Size: x • Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / 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. 4"," / / .� person Signature of responsible Da e TOM OF QUEENSBURY BUILDING & CODE ENFORCEMENT eV 742 Bay Road ;;�� Queensbury NY 12804 ,,,,_:44- (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name &eei2L__ l7,,-e__--, Location g7o cAeL- I / 9///��� /€4, Date / ��/ Permit # ���)1� SOIL TYP : Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length - '&) Length of each trench Liv , Depth of trenchesAili Size of stone ,A SEEPAGE PITS: Number Allim - Size - ft. x ft. Stone size PIPING: — Size Type Bldg. to Tank `f`" (! . Tank to Dist. Box V" ';\ Dist. Box to Field/Pit.. Irr. gp Openings Sealed? (Y- No Partial LOCATI ON1/SEPARATIONS: Foundation to Tank. r,,,,j_ feet Foundation to Absorption 10 feet Separation of Pits feet Conforms as per Plot P1 .n ) No LOCATION OF SYSTEM ON P 'OPERTY: (circle one) _ d..� Lef Front - Rear - t Side - Right Side Middle Front - MIddie Rear COMMENTS: SYSTEM USE APPROVED: f YES) NO Arrived: c✓.:,a Departed: Building Inspector TOWN OF QUEENSBURY BUILDING_& CODE ENFORCEMENT )\. 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location Daterr)( 1/-5ermit #39,222 SOIL TYPE4g0TW•. :a►,1 ay- Results of Percolation Test- (if applicable) Ra e-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: T,ot 1 Length 7O' Length of each trench 1--4 1? 1 Depth of trenches \ 7.1-c," Size of sto __ 1 SEEPAGE PITS: 111umbefr- Size - ft. xi ft. Stone size I PIPING: 1 Size Type Bldg. to Tank ' EwhTi a)G� L, Tank to Dist. Box ' QvC Dist. Box to Field/ i t . LPN Openings Sealed? Yes No . Partia LOCATION/SEPARATION : Foundation to Tank. �y.A.jl i i feet Foundation to Abso tion feet Separation of Pits feet Conforms as per P1 t Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: E 3C. 6 o G1-Oo D A-7-2- l►c.+a7\41/40 72..... a d .t, m) t \5"c-kv3CV V6 El.�_ b�o SYSTEM USE APPROVED: YES t NO Arriv-• __f, Dep. -'e'' Aillff Aiiiiir .or MIMI did_./.; .ui `'i'i .11- :pecto TOWN OF QUEENSBURY BUILDING_& CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name ,I �/ (�fe Location /,i ;61 ,20 Date Permit # SOIL TYPE: Sand-Loam-Clay- Results of Percolation T-st- (if applicable) Rate- inu a/Inch TYPE OF SYSTEM: ABSORPTION FIELR Tot:1 L:ngth Length of each t - c Depth of trenches Size of stone SEEPAGE PITS: Numbe, - Size - _ ft. ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Fielo/Pit Openings Sealed? Yes No Partial LOCATION/SEPARAT ONS: Foundation to Tank feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: / l'Ovf- �,lG'�i G/' .L / ?0/2 / f3 s�f/�., 2 2)Vie- CewJ a eti C4, 0`'� re/4.5/2e4 SYSTEM USE APPROVED: YES Arrived: 2 /. Departed: Building Ins ector TOWN OF QUEENSBURY BUILDING.& CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name `,/e� z2 �ree-A. Location !"//car-47..d Date /Z/i//0 Permit # /1-72Z- I l SOIL TYPE: Sand-Loam-Clay- Results of Percolatiqn -st- (if applicable) Rate Minu a/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total L'•ngth Length .of each tre h Depth of\trenches Size of st'o• SEEPAGE PITS: Nu •er- Size - ft x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Bo) Dist. Box to Fie 'd/Pit Openings Sealed? Yes No . Partial LOCATION/SEPARA IONS: Foundation to T<,nk. feet Foundation to 'A1'sorpti on feet Separation of Pits feet . Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: 9:04s �J��% ,, r' -A 4� ��6 � teak. 9 �A1,4 7i adz ,G Gar®u�� 4J681,c SYSTEM USE APPROVED: YES NO Arrived: ,7:93/ Departed: Building Inspector 7'O i96icic-)Gi Zieuo4 g d "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells,trees,fences,etc., shown on this document I also represent that I have personally m,eas&ured thQdist ces set forth on the diagram." SIGNATURE J DATE 77,< ;x\NNZi;•-• / ' pd, „:,:/.---• , (7\ri' 4X-66, - . ,, ,/--N/ / / ' V , .//yi, Z ._:__- .-/. . -.- -' ' • A ,• , \. ,,,, ,_. x„ ,,,,,,s,,v, io„ ,,,2L- ��� k�.4,1 , / r -) ) ,,. ., „ ., Da 2 p. 1999 G) G' P701 p OF QUEENRY #00 99772 46 :-2-38 En E �.. ....P.14: GREENE, JEFFREY & SUSAN 270 MEADOWBROOK -RD. V SEPTIC ALTERATION