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97-159 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date April 25 19 97 • 1 (4 •.97159 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 110 REVERE RD. Location ZUHLF:i , DWAYNE & SUSJ A.N -- Owner TAX HAP NO _ 1 25 . _4_-13 By Order of Town Board TOWN OF Q BURY bat, Director of Building & Code Enforcement BUILDING PERMIT VALUE $ 0 TOWN OF Q.UEENSBURY No. 97159 TAX MAP NO. 125. —4-18 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to ZUHLKE, DWAYNE & S1ISEAN OWNER of property located at 110 REVERE RD Street, Road or Ave. in the Town of Queensbury,To Construct or place a SEPTTC ALTERATION at the above location in accordance to application together with plot plans and other information hereto filed and approved and in with the Town of Queensbury Building and Zoning Ordinance. 1. OWNER'S Address is 110 REVER RD. QUEENSBURY, NY 12804 2. CONTRACTOR or BUILDERS Name CONDON SEPTIC & DRAIN SERVICE 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name 5. ARCHITECTS Address 6. TYPE of Construction—(Please indicate by X) SpPITIC ( )Wood Frame ( 1 Masonry ( )Steel 7. PLANS and Specifications SEPTC ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8: Proposed Use - : SEPTIC ALTERATION $ 25.-. • PERMIT FEE PAID —THIS PERMIT EXPIRES April 25 19 99 (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.) Dated at the Town of Qu ry this 25 ay.of • April 19 97 SIGNED BY L / for the Town of Queensbury Buildin and Zoning Inspector y ----'• ; A �plicationn tor SEPTIC DISPOSAL PERMIT O • - • SI'AMI' RECEIVED:1) /id Ralf tkE Pd. O . Location of properly for installation: I J� Owner's Name u/g-it) E. 2- u JJL. rl E -7? )- 6.70 k PERMIT NUMBER Owner's Mailing Address:Pp REv itk€ /1D ��AL Cri � rri 00 /�j G c 1'lili PAIL) ,� Z Installer's Name:�GN7d/ S sp/iC Phone #:79�-�5—�l� v y Number of bedrooms (if residential): // • Total daily flow (residential.-compute en 150 gal. per bedroom): Topography: IX flat _ L1 Rolling r—I Steep Slope °n of Slope Soil Nature: FA Sand r-] Loam r1 Clay Q Other —/Dittt Ground Water: at what depth? - fact Ail7I R!-CEIVED Bedrock or Impervious Material: at what depth? 11' feet aPR 24 1997 i:1 t;,i;.Ta:s���J��f Percolation Test: -,,, Not Required Q Required/Rate ntin. Z4rmiik- 14,,, CODE Domestic Water Supply: EXCI Municipal j ' Well rI Other If domestic water supply is a %VI:J.1.: water supply from any septic absorption is feet PROPOSED SYSl1 M: ` • ' Septic tank;1)44 gal, (minimum size: 1.000 gal.) '2,6 . Tile Field: each trench 0 feet. / total system length - feet. . Seepage Pit(s): number of / size each: ' ft-z ft. ' Size of stone to be used: # /// depth or thickness l feet. . - 11OLWING TANK SYSTEM: (if required) • • Number of tanks: Size of each:. gal. Alarm system and associated electrical work to be inspected by a certified agency. 1. • For your profec:Lion, please note that pursuant to Section 136-29 of the Ccide of the Town of Queensbary, any permit or approval grinrted which is based upon or is granted in reliance upon . any material misrei fesentatian or future to make a material fetct or circumstance known by or on behalf ofsrn applicant, shall be void. . 1 have read the regulations with respect to this application and agree to abide by these and all requirements o f the Tonvn of Qtreensbiiry Sanitary Sewage Disposal Ordinance. e Signature o f respoirsib'r person: Date: y3 i' TOM OF QUEE�1SBURY /t4')4 f' BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 ' SEPTIC DISPOSAL SYSTEM INSPECTION Name i ,)G\ L� Location 0 0 -evQ_J. ) Date ;, 4 7enit # 07 7-/ J 9 SOIL TYP 1111 1110, oam-Clay- r Results of '-rcolation Test- (iL ..e 'cabl : ) Rate-Minute/Inch TYPE OF SYSTE �� ABSORPTION FIEt D: Total L _�ggtfi Length of each rench 1 CJ - 11—eo5 Depth of trench;•s `r Size of stone SEEPAGE PITS: um.er- Size - ft. x ft. Stone size PIPING: Size Tyne, Bldg. to Tank L, x/' T/N& Tank to Dist. Box Dist. Box to Field/P' , il Openings Sealed? tlaV No Part' 1 LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption -? feet Separation of Pits eet Conforms as per Plot Plan No LOCATION OF SYSTEM ON PROPER ". (circle one) Front - - Left Side - Right Side Mi rout Middle Rear C SYSTEM USE APPROVED: 7,YES NO Arrived: "FA Departed: Building Inspector TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION NameV/t Location �l ;G6' /& Date 424 /Permit # SOIL PE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption 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: /47- ia2 - SYSTEM USE APPROVED: YES / NO Arrived: /9��U� l Departed: Building Inspector i nave seen or observed or Miro i sew evidence of all objects such as houses,tub,hoes,fencs4etc. shown on this decimal.1 also npraenttint 1 bare personally measured the distances set forth as the dam." / !i,� g-1.3 q7 SIGNATURE • DATE PLOT PLAN SEPTIC SYSTEM Notice: The following statement must be "stamped" on. your plot plan'. This sheet of paper may be; used for purposes of drawing your plot plan. After drawing such plot plan, 'please read the statement and sign it. If you choose to use other- paper for your plot -plan, the office will stamp those plans for your signature. ..-vet a s n1........- .r..•. .mn.. ...-v.rt..moar. ..:Gt�!-S.-y. TOWN OF QUEENSBURY BUILDING DEPARTMENT Based on our limited examination, _ compliance with our comments shall _ not be construed as Indicating the plans and specifications are In full .�„� ' compliance with the code. 1 APR 2.4 1997 TOVV OF UE �45 U � Tour 5 URv. , BU A{{ /• - � ' . ^ �y. DEPT. BUILDING.AND CODE REVIEWED By .�! g�/a �. is, • opY Skl . . °i ' ' . • f a• ., 1 .. ..viel ,.. .:. , , _,.-r_.., tt . - �►o - o Or gof'� PO t !/0 RE fiC/—t ,.