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99-112 CERTIFICATE OPT' COMPLIANCE TOWN OF .QUEENSBURY WARREN COUNTY, NEW YORK Date April 9 19 99 203,?0—. - D ! 99112 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 2 NEW PINE ST. Owner PERRY. BARBARA A. TAX MAP NO. 111 .-6-11 By Order of Town -Board (� ZY4 ' Director Of Building & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY VALUE . $ 0 No. 99112 TAX MAP NO. 111 . —6-11 •WARREN COUNTY, NEW YORK • • PERMISSION is hereby granted to PERRY, BARBARA A. OWNER of property located at 2 NEW PINE ST, • 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 2 NEW PINE ST. • QUEENSBURY, NY 12804 ' 2. CONTRACTOR or BUILDERS Name , • . • CONDON.'S SEPTIC. & DRAIN 3. CONTRACTOR or BUILDERS Address 0 • • 4. ARCHITECTS Name • • 5. ARCHITECTS Address • 6. TYPE of Construction—(Please indicate by X) SEPTIC • ( )Wood Frame ( )Masonry ( )Steel ( ) -7. PLANS and Specifications • SEPTIt ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8.Proposed Use • • • SEPTIC ALTERATION • • $ • 25. • • PERMIT FEE PAID —THIS PERMIT EXPIRES April .8 • 2001 19 . (If alonger 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 8 Day of Apr.i 1. 19 1999 • SIGNED BY • for the Town of Queensbury Building and Zoning Inspector . • Application for SEPTIC DISPOSAL PERMIT To of Queensbury Dept. of Community Development Permit No.0 Building &Codes Office ©� 742 Bay Road Fee Paid. S , Queensbury, NY 12804 • r l Location of property for instnitationq flf c , /iv S _ APR 0 (, Property Owner's Name: ,f`S KG4!y� .,�yy ps A61-7 - PropertyTovvNot Owner's Address: BUILDING': f�+[: Mailing ��c��U��h/ Ce• Installer's Name: Y!/t'6vrr _c DM-711/ Phone # --f ry Number of bedrooms (if residential): 2-- Total daily flow: 30 0 (residential -compute @ 150 gal./bdrrn.) Topograaphy: flat, rolling, steep slope % of slope Soil Nature: ) sand, loam, clay, other /depth: Ground water: at what depth?" ! feet / Bedrock or Impervious Material: at what depth?4!i feet � Percolation test: not requir., required [raze min. per inch J Domestic water supply: municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. PROPOSED SYSTEM Septic tank-r�/,Ct'' gallon (minimum.size: 1,000 al.) Tile field: each trench Vd feet / Total system Iength: '0 feet Seepage pit(s): ,number of / size each: . ft. by ft. Size of stone to be used: # - / depth or ti cloness feet • • HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each: gaaons (Alarm system and associated electrical Rork 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 apnuval granted which is based upon or is granted in reliance upon any misrepreseotaton 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 Queensbt-y S.nit ry Sewage Disposal Ordinance.Sib ature of responsible person: Date: �' D e TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name I F RR\1) Location 7 )E1.0 PIKE 81- Date Li--CI-CA Permit # 1211 l7_ SOIL TYP : Sand- oam-Clay- Results of Percolation Test- (if applicable) Rat: vinute/Inch TYPE OF SYSTEM: ABSORPTION lIELD: Total Length Length of each t -nch ,1 Depth of trey,che. - > _1--® 731` Size of stone; l SEEPAGE PITS: umber- Size - t. x ft. Stone size PIPING: Size Type Bldg. to Tan L/14,,4r Tank to Dist Box Dist. Box to Field/Pit ►r , \C. PFRF- Openings Sealed? Yes No Partial LOCATION/SEP1RATIONS: Foundation to Tank t() feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan CYes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Le ht Sid e Middle Front - 'ddle Rear COMMENTS: F1 -PLA • SYSTEM USE APPR YES ENO Arrive . Depar ed. uildin Iri pector • TOI4N OF QUEENSBURY � BUILDING & CODE ENFORCEMEN D 531 Bay Road Queensbury NY 12804 �o�� 0 518-745-4447 C0 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location 1 V Date— — Permit #DAq SOIL TYPE: Sand-Loam-Clay- Results of Percola ' n Test- (if applicable) R te- inute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of\ each tr nch Depth of trenches Size of stone SEEPAGE PITS: Nu ber- Size - ft. Stone size _ PIPING: Size Type Bldg. to Tank Tank to Dist. Bo Dist. Box to Fi ld/Pit Openings Sealed Yes No Partial LOCATION/SEPARA IONS: Foundation to Tank feet Foundation to Adsorption _ 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: H I O SYSTEM USE APPROVED: YES NO Arrived: Depart B " i ng p c or „ /r. • PC r iUivc ( (i r L rN-r•- 1 L.011)a10✓11 5 -:-)Cr rtect ivy r v cu°c v c c, e r,., ., 7 : rti&ei e rN£ S-t' , if 3/ t 9 y8 j//// `. p 'R //� /Y -- 7e�s-i-v z_ TOWN OF QUEENS UR' :it�� slc.;DEPARTMENT My N T ,zed an our limited examination, �Ompliance with our comments shall . iid PROJECT not be construed as indicating the �T plans and specifications are in full r Q 6` •u F® compliance with the code. to . . to t�.',� ry !Allf)., PmI FP: ° oF yo ��- ONST f N ^ d ' 1, �b C'6NCr@fti ��o 4. BUILDING ” e ,„ RECEIVEDD REVIEWED BY APR 0 8 1999 :._ c 99 —/fea_ ... . .,-,, . 1 .. l'_. ,';'.1. I:3 t" id eta l'AN K. TOWN 3I: QLEENSB Y. ��"'t DATE .IRsA TOWN OF p_UEEI'1SDUr • pp BU1LD1fVG qND CODE I` V l have seen or observed,or believe I saw evidence of, . a/ all objects such as houses,wells,trees,fences,etc., u/ shown on this document.I also represent that I have A . personally measured the distances set forth on the diagram. l SIGNATURE DATE • .............wt. n► ... r , - I _ • 67 rup.v live j 7 . fivivs _ o4s.64 g1rv1 Dlx w-q