1999-404 CERTIFIC 1 E 01 -:COMPLIANCE
:TOWN'` OF ,UUEENSBURY '
WARREN ''COUtI1`Y, NEW YORK
Date '. July 1 19 99
• 99404
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 " •
631 STATE ROUTE .149 location
PLLSCOFSKY,.: ANDREW, & DAWN. ,
• Owner
TAX MAP -NO;. 28 . -•1-35 By Order of. Town Board. - •
TOWN OF UEENSBURY
Director of B,ui�l.ding: .& Code: Enforcement
BUILDING PERMIT
VALUE $ 0 • TOWN OF QUEENSBURY No. 99404
TAX MAP NO. 28 . —1-35 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to PLISCOFSKY, ANDREW & DAWN
OWNER of property located at 631 STATE ROUTE 149 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. OWNERS Address is
631 STATE ROUTE 149
LAKE GEORGE, NY 12845
2. CONTRACTOR or BUILDERS Name
I .B. S. SEPTIC
3. CONTRACTOR or BUILDERS Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( I Steel ( )
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 July 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(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.)
1 • • July• 1999
Dated at the Town of Queen ury this Day of 19
SIGNED BY for the Town of Queensbury
Building and oning Inspector
Application for SEPTIC DISPOSAL PERMIT •
Town of Queensbury L
Dept. of Community Development Permit No. q V
Building &Codes Office
742 Bay Road Fee Paid '
Queensbury, NY 12804
Location of property for installation: 72, j , /
Property Owner's Name: A n ob e w Q L A'14 RECEIVED
Property Owner's Mailing Address: f y 9 a�Co JUL 0 1 19�9
.� ✓ TOW F C�UELIVaDURY
Installer's Name: J -iJ S', e,Q/i 4 Phone # r AND CODE
•
. Number of bedrooms (if residential): 3 Total daily flow: f D
(residential -compute @ 150 gal./bdrm.)
Topography: t rolling, steep slope % of slope
- Soil Nature: X sand, loam, clay, other /depth: _
• Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test not required, required [rate min. per inch]
Domestic water supply: municipal, Vwell, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
•
) /,cii
Septic tank; 12) gallon minimums 1,000 gal.)
Tile field: each trench d feet / Total system Iength: 6) feet
Seepage pit(s): number of / size each: . ft.by ft.
Size of stone to be used: # / death or thickness / feet
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: : Size of each: ;Trans
Alarm system and associated electrical week 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
appnvval wed which is based upon or is panted in reliance upon any material misrepresedv.ka 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 re trrements of the Town of
Queersbuty Sanitstry Sewage Disposal
Signature of responsible person: 44i _ Date: ! "/ 91
. ,J..%::1? �-.I',.!' '')_•._ _1eel:�-�-,!!In',1,_- .-1-�.1 A -�k%.'nle-lr)S:C V.11 -eAV AIA')AQ�fiNa•A.__'�it _V.4W lJ"kt: ftWilV Q:1/009,!"__!": ..APlPl'AQ1%)
gel .
ri
NI
THE NEW YORK BOARD OF FIRE UNDERWRITERS PPG ' l
4 BUREAU OF ELECTRICITY • ;
111 WASHINGTON AVE., SUITE 704, ALBANY, NY 12210 iN
I NOVEI IBER 0',,1 999 42 30299 7/9 7 H 456997 I
Ci Date Applicatiogel p No. on file IS
i THIS CERTIFIES THAT I}!
• only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of A
10
WIIA
'CL'tlnET J. TUCKE , 11 .LLRONGATc7 RD. LOT 9, Q1JEEIV°aot)RY, NY
• i ; l 1. 1 r.,
n the following locationI❑ Basement ❑ 1st Fl. ❑ 2nd Fl. Section-'`-Block ' Lot0.1
1i OC'TOBER 21, 1997
, was examined on and found to be in compliance with the National Electrical Code.. 0
WI q
• FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
' : OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. �-'
Oa
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
1' AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. CM H.P. NO.OFnFEET AMT. WATTS
WI P7.
jl SERVICE DISCONNECT NO.OF S E R V I C E tr!
i ii
METER NO.OF CC COND. A.W.G. A.W.G. A.W.G. i
rl AMT. AMP. TYPE EQUIP. 1 0 2W OM 3 0 3W 3 0 4W NO.OF HI-LEG NO.OF NEUTRALS .-,
-(. PER® OF CC.COND. OF HI-LEG OF NEUTRAL '47�'''
. li
tt
• OTHER APPARATUS:
ROUGH ONLY-2 fii
lr,
ti
1
a
W. t '
r.cj ... r - - A. r
ZA t1�
LLr °•�rrY 'T1s J. TUCKER T Z r 1 7t.. �'.
,,,,p ji
(ATE'N$BL1RY', . Y, 1280 ' <, 14.x '•, 0 ,"+ F.t-. GENERAL MANAGER l
i = Per Li
_iianyBoard if incorrect. Inspectors may be identified by their credentials. �q
.�• This certificate cote must notbe alteredIn manner; return to the office of the
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mpv FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
3130
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,
' \/ 1 . ,_.
Location (p ?� F}-c-
- Q i • 1
Date_/ l permit # g'"I " Z OL/
SOIL TYP' : Sand-Loa ' Clay-
Results of Perc." ati ‘n est-
(if applicable) Rat—Min to/Inch
TYPE OF SYSTEM: I
ABSORPTION FELD: otal L:ngth gdo _
Length of each tre chi ► v
Depth of tren ,hes \.
Size of stone j ?
N'tj —
SEEPAGE PITS: ,,eN-
Size - ft. x ft.
Stone size
PIPING: Siz Type
Bldg. to Tank
Tank to Dist. Bo. Ov
Dist. Box to Field! ' '"
Openings Sealed? Yes No Partial
LOCATION/SEPAR.ATIO •
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits eet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERT .
;)
(circle ol..
Front - Re; - Le t Sid - Right Side
Middle •ront - Midd e Rear
COMMENTS:
Vie-- ^ 0.
SYSTEM USE APPROVED: Y NO
Arrived: .D-%qT
Departed:
Av_&
Building Inspector
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