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95-295 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date May 24 19 96 95295 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 Location •30A GLEN LAKE RD . Owner t.DINEEN , KEVIN —_- TAX ttAI tau , � , 1 31 By Order of Town Board TOWN OF QU ENSBURY Director of Building & Code Enforcement BUILDING PERMIT VALUE $ 0 TOWN OF QUEENSBURY 95295 TAX HAP NO. 40. -1-31 No. WARREN COUNTY, NEW YORK DINEEN, KEVIN PERMISSION is hereby granted to 30A GLEN LAKE RD. OWNER of property located at 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. OWNER'S Address is RIM BOX 30A QUEENSBURY, N.Y. 12804 2. CONTRACTOR or BUILDER'S Name BELL, IVAN 3. CONTRACTOR or BUILDER'S Address 516 BIG BAY ROAD QUEENSBURY, NY 12804 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) SEPTIC ( 1 Wood Frame ( 1 Masonry ( )Steel ( 7. PLANS and Specifications SEPTII' ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8. Proposed Use SEPTIC ALTERATION $ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES December 18 19 97 (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.) Dated at the Town of Queensbury this 18 Day of December 19 95 SIGNED BY - for the Town of Queensbury Building and Zoning Inspector I-1 . • . - -• • V. 1" a •f,z, - H Application for SEPTIC DISPOSAL PERMIT 0 STAMP RECEIVED Location of property for installation: /-, Js-L- c 2d o�7 e,t /� Owner's Name /--k— �.e/A / r 41// 6 >) -e e� I:Ith I'I'NUA1 31?It Owner's Mailin Address ! r�J [4 C 2Irri 6 : ni ZOe /� cf� 1 131? 1'Atl)Installer's Name: V A ( Phone #: 29, , �� i M Number of bedrooms (if residential): 3pzi q- se )..- Total daily flow (residential - compute (fi' ISO gal. per bedroom): l•opogralrhy: flat I-----1 Rolling I—I Steep Slope "S% of Slope, Soil Nature: I I Sand I I Loam Mil I I ('lay �Ulhcrg rC /Depth: Ground Water:` at what depth? feet Bedrock or Impervious Material: at what depth? .e'er— feet Percolation Test: I I Not Required Required/Rate ` min. per inch Domestic Water Supply: I I Municipal I)(Well I I Other If domestic water supply is a WF.L.t: water supply from any septic absorption is feet PROPOSED SYSIFM: RECEIVED Septic tank:. S® gal. (minimum size: 1,000 gal.) JUN -061995 Tile Field: each trench feet. / total system length feet. r, OWN OF QUEENSCODEBURY /� BU ILDING AND Seepage Pit(s): number of /.—.) / size cacti: ft. x t ' ft.Size of stone to be used: # / depth or thickness __ feet. HOLDING 'TANK SYSII?M: (if required) Number of tanks: Size of each: gal. 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 ('ode of the Toni: of Queensbury, any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to ntalce a material fret or circumstance known hr or on behalf of an applicant, shall be void. 1 have read the regulations with respect to tl ' application and agree to abide by these and all requirements o f the Town of Qtree nsbury rr nary Sewage 'spy. Ordinance. . Signature o fres onsib'e person: C Date: : _7 COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 357 Elwyn Terrace — Manheim,PA 17545 v. MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL Panel Board No. Cert. Cut-in Card No. Owner "'CV/ / / L1 A Occupant p Location 0% '� /iL L /E , a2f.L-XJrty Installation Consisting of.. . . e PaAIi to v do oti 7-12QC Installed By r, BG2 / 65 S c PLic. The conditions following governed the issuance of this certificate,and any certificate previously issued is cancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon the introduction of additional equipment or alterations, application shall be promptly made for inspection. Inspectors of this Company shall have the privilege of making inspe A..1 s at any time, and if its rules are 5violated,the Company/ shall have the right to revok th. certi t Date -a-S C?...(P INSPECTO r 4/./ /C n Member N.F.P.A.,I.A.E.I. q71°\ TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION a Name I r"c;- 1P -N j 4()1r\ Location f--5 r'r-c -( Date 1 9� Permit # - ��5� SOIL TYPE: Sand-Loam-Clay- � c Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number- Size - ft, x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field Pit Openings Sealed? x Yes No Partial LOCATION/SEPARATI Foundation to Tank feet Foundation to Abso tion feet Separation of Pits _ feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM PROPERTY: (circle one) Front - Rear - Left Si e - Right Side Middle Front - Middle ear COMMENTS: • SYSTEM USE APPROVED: YES *=2 Arriy/ed t Dep 0: Build ng I p for f TOWS CF QUEENSBURY f"7 ' BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name -clk,rI\ILQ ` le-A-K Location _ '�t J\ �oo Dates ,`%(9 Permit � 5 SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELDi Total Length Length of each t ench Depth of trenche Size of stone 1 SEEPAGE PITS: Nu ber- Size - ft x ft. Stone size PIPING: Size Type Bldg. to� � I Tank t® P . . ! V- '��1 4)C",1-� LlU Dist. Box toF' d/. jt Openings Seal: '? R ► N: 'artia LOCATION/SEP TICS Foundation o ; ' feet Foundati. to Absorp . i���`' __ feet Separat'on of Pits feet Confo, s as per Plot P an ` es No LOC ION OF SYSTEM Of 'OPERTY: (c'rcle one) • ront - Rear - Left Sid: - Right Side Middle Front - M d e Re,r COMMENTS: 01, k Oijk? LLED SYSTEM USE APPROVED: YES Arrived: ;1,` j Depart . Bui ding Inspe or • - , TONN OF QUEENSBURY J ) BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name 'C-)1 :`j c =`1� )(e_v h A Location 30 n �G/o � G�c ,--- Date �lp �'�r. Permit # J SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inchf TYPE OF SYSTEM: / ABSORPTION FIELD: Total `Length Length of each trench Depth of trenches Size of stone — SEEPAGE PISS: Number-WA Size - ,( ft. x ft. Stone size :1 - gmr PIPING: if Size Type Bldg. to Tank 0 , ‘t iM Tank to Bi st. BMX D i Field/fit LA"" Openings Sealed? / Y'e . No arts al ' LOCATION/SEPARA ' 'oNS: Foundation to nk IV-) feet Foundation t Absorption k� feet Separation f Fits — feet Conforms a per Pl of Pl :n LOCATION OF SYSTEM OF P'OPERTY:�: (circle one) Front - Rear - Left Side - Right Side Middle Front - l e Re.r COMMENTS: \--70VA? C_, \VMR7VV--- tit t9'LI_ SYSTEM USE APPROVED: -- Y S NO Arrived: % �', Departed- ui ding Inspe t w // / TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name ,il/ti s e< Location "� � ,e, Date /' 7 4; Permit # ( 4 �� SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number- Size - ft. x ft. Stone size _ PIPING: s Size Type Bldg. to Tank Tank to Dist. Bo i Dist. Box to Fie Pit Openings Se Yes No Partial LOC PARATION Foundation to Tank feet Foundation to Absorpti _ 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: — Ok 4 v-e- ,72 1/ Z/"--e- -,e',e-41e 61,A, d 4 5e4 the/ F /77 74 - SYSTEM USE APPROVED: YES NO Arrived: /.:3o Departed: Buildin spector