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2002-824 TOWN OF QUEENSBURY 742 Bay Road,QueensbmT,NY 12804-5942 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number: . P20020824 Date Issued: Monday, October 07,2002 This is to certify that work requested to be done as shown by Permit Number P20020824 has been completed, Tax Map Number: 523400-297-010-0001-017-000.0000 Location: 33 WINCOMA Dr Owner: PETER&LORI WERBLOW Applicant: PETER&LORI WERBLOW This structure may be occupied as a: By Net of Town Board Septic Alteration Residential TOWN OF QUEENSBURX Nectot of Building&Code Enfoteement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020824 Application Number: A20020824 Tax Map No: 523400-297-010-0001-017-000-0000 Permission is hereby granted to: PFTFR & LORT WERBLOW For property located at: 33 VVINCONM 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: PETER&LORI WERBLOW Septic Alteration Residential 33 WINCONIA Dr Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name Address Electrical Inspection Agency PFTF WERBLOW NY 12804-0000 Plans&Specifications 2002-824 Residential septic alteration per plot plan and specifications. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 01,2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the own 0 October 01,2002 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Am3lication far SEPTIC DISPOSAL, PERMIT Town.of QueensburyVtl Dept. of Community Development Permit No �i Bu ildkq&Codes Office 742.Bay Road F{ee P2id�$ N Queewbury, NY 12 O l 3 � L— __ SEP 3 0 2002 Location`of Property for installation: ' W!&ICu /,46 L/4^1 L TOWN OF OUEENSBURY Property Owner's Name: 17 -t"r �-.' . �) Z.C � c�c= .�— l ! fs� �:Oq Property Owner's Mailing Address: ,r.a 1. Co vv� 1 L r42. Installer's Name: r=�` - tZ Le,)1=-GLNW,�., Phone # 3 -1.2.-3 Number of bedrooms (if residential): 3 Total daily flow: Qs . (residential -compute @ 150 gal./bdrm.) Topography: .fiat, rolling, stew slope % of slope Soil Nature: sand, -loam, clay, other[depth: Ground water: at what depth? feet I Bedrock or Impervious Material: at whai depth? feet Percolation test: not rectared, required [rye min..per mi ch 3 Domestic water supply: municipal, )well, other Is"domestic water supply is a WELL, water supply from arty, septic absorption is_� 00 feet. PROPOSED SYSTEM T Septic tank gallon (minimum size: 1,000 pl.) Tile field: each trench 2 n" feet / Total system Im the L. feet Seepage pit(s): number of I size each: . ft_by fL Size of stone to be used: # / depth or thickness feet . HOLDING TANK SYSTEM: '(if required) Number of tanks: Size of each: ganons Alarm system and associated electrical stork to be inspected by a certified sgem,. For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Qoeensbmy, any permit or approval•,granted wbich is based upon or is granted in reZiamce upon my material misrepr edatioa or failure to make a material fact or circumstance known by or on behalf of an applici, shalt be void, I have read the,regulations with reepwt.to this application and agree to abide by these and all re -'rements of this Town of Qaeersbsrry Sanitary Sewage Disposal ordinance. 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