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2000-472 Certificate of Compliance Town of Queensbury Warren County, New York DateJuly 5 , 200o 0 This is to erti fy that work requested to be done as shown by Permit No. has been completed. This structure may be used as a � _ SEPTIC ALTERATION 15 HOLDEN AVE . Location Owner � HERMANCE I.J T. WAR. �g £x SARA! T TAX MAP NO , 1 1 7 , - 10 - 1 1 By Order Town Board TOWN OF QUEENSBUIC tY Director of Build fg & Code Enforcement r BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury, NY 12804 County of Warren (518) 761-8256 VALUE 0 Building Permit No. 2000472 TAX NAP NO . 117 . - 10 - 11 Permission is hereby granted to HE.RNANCE a E©WAR© & SA.R.AH Owner of property located at 15 HOLDEN 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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Owner's Address: 15 HOLDEN AVE * QUEENSBURY , NY 12804 Contractor or Builder's Name: SANITARY SEVER Contractor or Builder's Address: DAN DRELLOS PO SOX 224 GLENS FALLS NY 12801 Electrical Inspection Agency_ Type of Construction_ Plans and Specifications: SEPTIC ALTERATIOONA.- A"�..PER. PLOT: .: PLAN.,.SPECIFICATIONS Proposed Use; SEPTIC ALTERATION 25 a:. _ :_ . _. . ,: .Tiny 3 2002 $ PERMIT FEE PAID — THIS PEANUT EXPIRES of 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.) 3:L .,, . ,',.u,:.,. ,Jtatly:. : 2000 .. Dated at the Torun bury this _ _ • Day o� SIGNED BY (R for the Town of Quecnsbary Code Enforcement Officer f___yJ Application for I'clllui[ . Sv1)ti4 Disposal Systom Tolvil of Q11crefi.rl#rrly 7.1213r � 1s'rr�rrl Jrlc�c;rrslaurs, NV 12804 (.518) 76142.56 1, OWNER INFORMN1910N; . .................................... ___. .__,................ Locatiotl orirtstallatiolu zS e ole'ti AVE office uxe ? Tax Mno) No. l / Pilo floe rrtit No. _L cs`- � J "i' •�+ "y C7wnar"s Nnntq: /Z to �r �y,,T�, Iron Paid � 2`> . ...... Ad /�1 t1 2. INSTALLER'S NAM 13 Trig r+< 'c c y c PHONE N(7. '�•Z '7 2 J`."� 3, RESIDENCE INFORMATION: (cllolo or )renl• of d 11 bcs4h-ovltr(j) alld ltluitiply # rr/. 8tc1r•rrurarx with apilIicab10 );rrllurr,r Pet- betlrerrrrrr to c(ltlaI !front rhrill,flolr') Y.pAr Qf J louNo. or Dcdrvat is x rZ a �.crg� i1�:1 lUtl til�"u[�i U:�I�I _ a } f a,... 1980 or older 2 _ x 150 Bali/bdilit = 00 JUL U 3 2000 1980 — 1991 x 130 t;a#/b(itfit ::� ;' : ; 1991 -- lrrescut � x I 10 g,al/bdr rn — . �_{ Garbage Grinder Installed yes / Ito Spa or VA)iriltool Itesta[led yes •f. PARCEL fldFopC MA'I'I(]Na (circle applicable inforlrratiort & indienta elroasoroltlorrts) � 4it1�1rY 5v'_ . _ rio C,lte�illlCl� iltCr � Cij1,VC�G 11�i11111Cr_WkVIIS_ #ltClinj { errr<T ur ►►•hert .lelrlh rr1 lr•herr rleppih �Vntc1JS1►I,laly raJJlrrf; Mrrrl feet .5ileesp sJnJre chry I`'r'r tre#T r �°r& alupd o#har If tueU; turner srgrrpl), deJrllr: f i urrt tray .rcrplic -xy:r#crrn absu#p#lulr Is ft. Iaercolation "1'ost: (1 i� bri c'ulr►J+lclec! by !lcelr.scd Jrrccsssiv#rcrl e#rglr#eer car urr h1#c�C1) other _ Nate: #IrNlrrJe Jrer lrrclr 54 PROPOSED SYSTEM,; Cor New Consinictioli: All Individilarl selv,'Ige disposal s}'S(Cnls Most be dcsil;ticd by it liccnscd IatofcssianA cltglrtecr or sirchitcct (nn[css inslalllcd oll .t 1'larniri"r, 13tl:u(1 111Vloved subdivision). Alhl 25() l,;r[lrins ter Ills si c of the seltiic lank said le felt licld for c,tcli (,mltb.rgc tilintict, Spa or Whii1i„rol '['trb. Septic Tank: oyc) gcallval (fair. size J OOU grrl.J 'Pilo Mold: each lr•errch `/ r� �jr Total System I.ollgth; Seepage Pit(s): rrrember of size rtf'ecrch: jl- Size of Stereo to be used: 1# /t.} / d#ey,th Ued Systont Size: x Altertiative Systeltt: lerll;th rrlrrllur .slze G, HOLDING TANK SYSTEM: (if required) Numbor of tanks: 1 Size of eacil: gallons ! 'I UTAL Capacity: IT'allons Noty Alarm System and associated electrical work must be inspected by ., Town approved olectricai inspection agellcy. 7, SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please read) For your ptoroctiorl, Plea R0 nvto room pill seenrrt to Section 136-29 of Ilse Cvde of dia 'vown orQtlecrtsbory, any perllrit or altprovn[ grnrltecl which is bnsnt! ullorl or is o;tnrltncl in relinllco [plot nrry 111ntor in r t t int v I 1 I CS or ttatior r or o:1111rr010 IIIn l<o n 121:1101 in fact or circnrrrstnrlco knclwrr by or cart bobalforarr epplienllt, shall be voitl, I ltnve reat] lore rn}ltr lilt iotla will% 10-4:Vect to ltlim nrltllicntiorr nisa strtroo to nbiele+ by obese nnel nil roq�u'i�ro/m�o fllre 'I'otivn of (ZtrcensLlrrry Snnitnry Sowago 13isposnl Ultlirr:lrrce. V c� lgnatur•e elf resspanslbfg per:�orf d e JUL o 3 2000 op MENSO l l s� I f } e�, i I1RY id exjrni C TMEi4T y , based on our limited examilra COP 11 i cornpliancevAth our cornment"ll E not be construed as indicating the plans and specifications are in Ul compliance with ?he. coda. "I have seen or observed, or believe 1 saw evidence of, TOWN OF Q{„! ENSBUR all objects such a ouses, wells, tr es, fences, etc., -r i BUILDING �, (] on th s 1 al r resent that I have REVIEWED B Prso ally me s es set forth on the/diagram ." � DATE S! fi4 TURE ATE