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1999-133 • CERTIFICATE OF. COMPLIANCE TOWN OF QUEENSBURY S WARREN COUNTY, NEW YORK Date Apr 11 19 19 99 99133 This is to certify that work requested to be done as shown by Permit No. has been completed. SEPTIC ALTERATION This structure may be used as a 29 NELSON RD. Location , CL11TE, LARRY Owner . TAX MAP NO. 36 ,--4-75 By Order of Town Board TOWN OF QUEENSBURY . • 1.1110, Director of Building & Code Enforcement Application for SEPTIC DISPOSAL PERMIT Town of Queensbury L3S Dept_ of Community Development Permit No. gq Building &Codes Office 742 Bay Road Fee Paid S Qa Queensbury, NY 12804 Location of property for installation: // (ç HECEIVED Property Owner's Name: P ® C� G APR147999 Property Owner's Mailing Address: d�C& Installer's Name: t 0, S t5- ! f Phone # Number of bedrooms (if residential): Total daily flow: ) (residential - compute @ 150 gal./bdrm.) Topography: ?cat, rolling, steep slope % of slope - Soil Nature: Krand, loam, clay, other /depth: Ground water: at what depth? eet / Bedrock or Impervious Material: at what depth? feet Percolation test: / not required, r5quired [rate min. per inch] Domestic watersupply: f4 .unici aI, well, other P If domestic water supply is a WELL, water supply from any septic absorption is feet. PROPOSED SYSTEM Septic tank/gOb gallon (minimum size: 1,000 sal.) Tile field: each trench feet / Total system Iength: feet Seepage pit(s): number of / size each: .€t. by 7_ ft. Size of stone to be used: # 3 / depth or thickness / feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each: gallons . l (Alarm system and associated electrical work to be inspected by a certified agency. 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 circn*natance 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 gAnitary Sewage Disposal Ordinance. Sib ature of responsible person: r Date: BU ILDING PERMIT VALUE $ 0 TOWN OF QUEENSBURY No. 99133 TAX MAP NO. 36. —4-75 WARREN COUNTY, NEW PORK PERMISSION is hereby granted to CLUTE, LARRY OWNER of property located at 29 NELSON RD. Street,Road or Ave. 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 Town of Queensbury Building and Zoning Ordinance. 1. OWNERS Address is 13 DAWN RD. QUEENSBURY, NY 12804 2. CONTRACTOR or BUILDERS Name I.B.S. SEPTIC 32CLOWER CONTRACTOAddress R or QUEENSBURY, NY 12804 4. ARCHITECTS Name 5. ARCHITECT'S Address 6. TYPE of Construction— indicate (Pleaseby X) SEPTIC ( 1 Wood Frame ( I Masonry ( 1 Steel ( 7. PLANS and Specifications SEPTIQ0ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8. Proposed Use SEPTIC ALTERATION 25 April 15 2001 $ PERMIT FEE PAID—THIS PERMIT EXPIRES 19 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) 15 April 1999 Dated at the Town of Queensbury this Day of 19 SIGNED BY � A — ,r for the Town of Queensbury Building and Zoning Inspector ll J---- 'Pr- TOWN OF QUEENSBURY cf-Ziqf BUILDING & CODE ENFORCEMENT l 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION N a e ,L r t! c-J Location _ .,Date Lt / q Permit # d Jj3 SOIL` TY EAR an+ oam-Cl ay- Resul is or ,Percol a 'ion est- (if applicable) ILte-Min to/Inch TYPE OF SYS EM: ABSORPTION ELD: Total L:ngth Length of eac t ench Depth of trenc Size of stone SEEPAGE PITS N m61.7 Size - 48 f . x ft. Stone size ., PIPING: Size Type Bldg. to Tank 1-1 "_ Llj Tank to Dist. Box sD Dist. Box to Fi -1 d ti lo t',4A7t:3c Openings Seale0410Z010 ► ._ Partial LOCATION/SEPARATII" Foundation t91Tank Ec t4i feet Foundation too Absorption -Z E) feet Separation ,of Pits _ eet Conforms as per Plot Plan Y LOCATION OF SYSTEM ON PROPE (circle one) Front - Rear - L • - Right Side Middle Fron - Middle Rear COMMENTS: SYSTEM USE APPROVED: YES NO Arrive' . N. Depar ed: ./.✓ 4 41 P B' l 4 ing Ins - or 14 tl `s' ��\( �, 1\ I r �"' - C1 I C t 1 1 1 � 1 I l - - 1 I C /� �t � � I 1 I 1 ( , /III I td I. I t L f' , f�1 7'. I 1 1 1 :,I0 � seen Or,o �CrA°�.r•' ° — ue r 4r� P_ 1 u 1 BBBurh: �� 1,7, at, 1 1 . . . ' ' rii(r , , ' , , . . . �u (. j rees ,r'e_i:jibil.'.,es-,,,,'Ft',thId�3 ai G l , d . ,, ., . person"r'l4�6 F k .. G�wC e4� the nC Huh f�` • • 1f I �I ' • r4 1 , , I'I 'I I I , 1 --: .7- : 1, -, .7 --: -:- '-7 9 ;:, i , , :: ,, ; .1 :: : ,, 1 ; ; ; . „ , : 1 : .:: , ; f�/. , . . ,, . ., d 11 q. . 1 I I I ( -tea':, 1 _ I! \. ✓rs. 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