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98-519 CERTIFICATE OP COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Date August 25 19 98 Lo 98519 i This is to certify that work requested to be done as shown by Permit No * has been completed . SEPTIC ALTERATIQN This structure may be used as a -- - 57 SULLIVAN PLACE Location Owner RANDYRIVETTE , RANDY TAX MAP NO . 38 . - 1 - 4 By Order of Town Board TOWN OF QU N URY Director of Building & Code Enforcement ,,. ..�. BUILDING PERMIT VALUE $ a TOWN OF QUEENSBURY No. 98519 TAX MAP NO . 38 . - 1 - 4 WARREN COUNTY. NEW YORK PERMISSION is hereby granted to RIVETTE 57 GLEN LAKE R Street, Road or Ave. OWNER of property located at In the Town of [Quieensbury, To Construct or place a 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 Oueensbury Building and Zoning Ordinance. t. OWNERS AddI is 57 GLEN LAKE R© . LAKE GEORGE , NY 12845 2. CONTRACTOR or SUILDERZ Name QUEENSBUR.Y SEWER 2. JAY CONTRACTOR of S RuILOE S Addr*m SWE 0 4. ARCHITECTS Name 5. ARCHITECTS Address S. TYPE of Corrstruotior+ — SPleese indicate bw X1 SEPTIC l i Wood Frame i 1 Masonry S I Steel 1 1 .— i. PLANS and S1300M Moons SEPTQC? ALTERATION AS PER PLOT PLAN SPECIFICATIONS a. Proposed Use SEPTIC ALTERATION 25 August 25 2000 $ PERMIT FEE PAID - THIS PERMIT EXPIRES 19 Slf a longer period Fs ngvStad an applioetion for an asatenoon nwat be made to the Sufldlrsg and Zoning inspector of the town of [1ueeMburw b'mr a the ewpiration =1125 August 199 8 Dated at the Town of Queensbtrry this Day of 19 for the Town of Queensbury SIGNED BY _, Sulldisra and Zoning Inepeotor Application for SEPTIC DISPOSAL PERMIT Town of Queensbury Permit No. C Dept. of community Development, Building & Codes Office ✓ �-_ 742 Bay Road Fee Paid $ Qtiueensbury, NY 12804 Location of property for installation: -K t r h G1 a ) > L Property Owner's Name: Property owner's Mailing Address: Installer's Name: " �,,�- ;4 or !�a Sre L .i' Phone # ` -a7 3 C Number of bedrooms (if residential) : _� Total daily flow: ' z. (residential - compute 0 150 gal./bdrm.) Topography: _ flat, rolling, steep slope % of slope wsocl 199$ Soil Nature: sand, loam, clay, other I depth: Ground water: at what depth? feet I Bedrock or Impervious Material: at what depth? . feet Percolation test: ..�<, not required., required [ rate min, per inch ] 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./ (mitumum size: 1,C?QO gal.) Tile field: each trench feet I Total system length: feet Seepage pit(s): number of / size each: ft, by ft. Size of stone to be used: # �, I depth or thickness ,% ' feet ti HOLDING TANK SYSTEM.: (if required) Number of tanks: Size of each gallons P.larm system amd associated electrical vcrork 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 Queembury, any permit or approval granted which is based upon or is grunted in reliance upon any xnaterial misrepresembKbOn or failure to ma]©a a material fact or circurnstance 'known by or on behalf of an applicant, shish be void. I have reed the regulations with respect to this application and agree to abide by theee amid all requzemer is of the Town of Qoeensbnry Sanitary Sewage Disposal ordinance. '] Signature of responsible person: r/ ,t _ Date: 'F TOM OF QUEENSBURY BUILDING A CODE ENFORCEMENT 742 say Road Queensbury NY 12804 (518) 76I-9256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Ilk Location Date � - 7 + Permit #,'i - - --W� . SOIL TYVXZZjL -cl ay- Results of Percolation 'test- ( if applicable ) Date-Minute/Inch TYPE OF SYSTEM: ` l ABSORPTION FIELD: Total Length Length of each trench 4 � I Depth of trenches * Size of stone ��—�- SEEPAGE PITS : Number- Size - = Stone size - ft . PIPING : Bldg . to lank ize ype Tank to Dist . Box - ,s Dist - Box to Field/Pi r #� Openings Sealed? rALaIJ Yes o ParitIIIII LOCATION/SEPARATIONS: Foundation to Tank Foundation to Absorption I feet Separation of Pits -- - feet et Conforms as per Plot Plan LOCATION OF SYSTEM ON PROPERTY: ( circle one) _ e�=} Ream tt Side' g c*T-e^Fr^ont - hTM d7 e g" Right Side COMMENTS r SYSTEM USE APPROY€D IN Q59;- NO Arr ' 7ved: Depart . i k ilding n ctor € I i TOYS! OF QUEENSBURY BUILDING A CODE ENFORCEMENT 742 Bay Road Queensbury MY I2804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM ,,rINSPECTION Name �'I '� �ae Location Date Z Permit # ] SOIL TYPE: Sand- Loam- Clay- �1 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 T Stone size PIPING : Size Type Bldg . to Tank Tank to Dist . Box Dist , Box to Field/Pi t Openings Sealed ? Yes No anal LOCATION/SEPARATIONS : Foundation to Tank feet Foundation to Absorption feet Separation & Pits feet Conforms as per Plot Plan lees No LOCATION OF SYSTEM ON PROPERTY: ( circle one ) Front - Rear - Left Side - Right Side Middle Front -- Middle Rear COMMENTS : / Tom' Ive4.4 SYSTEM USE APPROVED: YES NO Arrived : )w Departed: Building Inspector TOM OF QUEEMSBURY BUILDING E CODE ERFORCEP031T 17 ] 742 Bay Road Queensbury MY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location %4401 -A, Date Permitre i SOIL TYPE : Sand- Loam-ClaResu] is of Percolation T Of applic le } Rate-Min TYPE OF SY ABSORPTION ELD : Total :1 Length of ea h trench Depth of tren hes Size of stone SEEPAGE PITS : umber- Size - x ft . Stone size PIPING : Si ��i ze Bldg . to Tank Tank to Dist . Box Dist . Box to Field/P Openings Sealed? e No artia LOCATION/SEPARATIOM Foundation to Tank feet Foundation to Abso tion feet Separation of Pits e feet Conforms as per P1 t Plan Yes No LOCATION OF SYS ON PROPER Y: ( circle one ) Front - Rear - L ft Side - Rig Side Middle Front - M ddle Rear COMMENTS : MiDy LsNq - SYSTEM USE AP ROVED : YES Arrived : Depart ding n ec or TOWN OF QUEENSBURY C"x ?- BUILDINB ,N CODE ENFORCEMENT 742 Bay Road ` - Queensbury MY 12804 - (518) 761-8256 .L 1 SEPTIC DISPOSAL SYSTEM INSPECTION Name � • Location Cy - � % � Q co 1 Date ermit # C SOIL TYPE . 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 . Sox to Field/Pit Openings Sealed ? Yeses a' Tti a� LOCATION/SEPARATIONS : Foundation to Tank feet Foundation to Absorption feet j Separation of Pits feet Conforms as per Plot Plan - -`des No LOCATION OF SYSTEM ON PROPERTY: ( circle one ) Front - Rear - Left Side - Right Side 1. Middle Front - Middle Rear COMMENTS : / I} eNp� Cite-- Ivew+ t � �n /iyv✓ ' l i SYSTEM USE APPROVED: YES NO Arrived : If& Departed : Building Inspector MRP \ ry RP ""I have seen or observed, or believe toosiaw eviftnce of, all objects such as houses, Wells, trees, 'fences, eu , shown on this document t also represent t!at I har> personally measu distances set forth tn the diagram SfGNkTURE E 1 JRV r `ti ram- rn f - - } / i r 77nn p • NF�� �5 . .. •rn D if �✓el A yf