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2002-518 TOWN OF 'QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICAT E OF COMPLIANCE Permit Number: P20020518 Date Issued: Tuesday,June 25,2002 This-is to certify that work requested to be done as shown by Permit Number P20020518 has been completed. Tax Map Number: 523400-301-013-0001-024-000-0000 Location: 22 LESTER Dr Owner: RONALD&SHEILA DOWD Applicant: RONALD&SHEILA DOWD This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY '( 6; Director of Building&Code Enforkk TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 L Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020518 Application Number: A20020518 Tax Map No: 523400-301-013-0001-024-000-0000 Permission is hereby granted to: RONALD & SHEILA DOWD For property located at: 22 LESTER 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:, RONALD& SHEILA DOWD 22 LESTER Dr Septic Alteration Residential Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency IVAN BF,TJ. NY 12904-0000 i Plans&Specifications 2002-518 Septic $25,00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,June 24,2003 (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 Q eensb ; �l �V/ da , u 002 SIGNED BY � for the Town.of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Towij of Queensbilly 742 Bay Mnul Qlleellsbuiy, NJ' 12804 (518) 761-8256 1. OWNER INFORMATION: ..............._..................................­....................­­................................................ Office Use Location of installation: 6r C. - �� - Tax Map No. File Pat-mit No. P _61 Owner's Naine: Fee Paid. Address: 4_taj 6 CTIP_"C7/' P C L/C_ ......................­.........................I................................... .......... ................... 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATION; (circle year of dwelling, indicate #bedroom(y)and multiply// of bedrooms with applicable gallons per bedroom to equal total clailyflou) Year of House: No..of Bedro9jiis_... x Computation = Total Daily Flo 1980 or older x , 150 gal/bdrin = 1980- 1991 x 130 gal/b,drin = 1991 —present x 110gal/bdrin = Garbage Grinder Installed yes Spa or Whirlpool Installed yes no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements)I l op-)pP LV Jjts a rial ater s�miyj7Ti� ll I r depth at S II Pth a eel eel steep slope clay if ivell; vvater supply slope other fi-0111 any septic-system depth: absoiption is other Percolation Test: (To be eanipleted by h architect) engineer or architec Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by licensed professional engineer or architect(unless illstalled in Planning 13oardal-4nowd subdivision). Add 250 gallons to flic size of the septic tank and leach field for cacti Garbage Urinder, Spa or WltirlpoulTub. Septic Tank:-Argoe gallon(min. size.1,000 gal) Tile Field: each trench Total System Length: Seepage Pit(s): number of size of each: _ft. by Size of Stone to be used: depth or thicklrexx A..--Cl/ Bed SystemSize: 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 perinit or approval granted wlticii is based upon or is granted in reliance upon any material 111isrepresentatioji or failure to make illatcri.11 f".Ict or circumstance known by or on behalf oran applicant,shall be void. I have read the reputations with 1-ovect to this application and agroo to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Signature of responsible person C f Date ro OIJ 4J0 v �, vl 'l' 0Q vz a CL 4J Q) v v Or ' � u 0 w 4J�w d N \ SIB 0 Q1 W v 4J (D i co i ro Or r .�. r• UI 0 . Q; 0 z z 0,;,, W U G FE WWcgz of E I 0 6 4J C r v VI , Q1 W Q1 E or 0 0 U G. 4� s a C n W � CL td +' 4-) ,0 S- 0 -P *0 a cr d to �,, 0 (0 0 0) iI E �� `0 © ,Y+ �0 0 rr-��( ti " W IL Ul r4 I o C3 v 4. v ai led ro.0 ,r. 0Ito s C Q1 r- U r—rj 0 0 0. 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