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97-700 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK PD\^ Da to November 2 1 19 97 \ 'CD 97700 This is to certify that work requested to be done as shown by Permit No. has been completed. S• This structure may be used as a �' TIC ALTERATION Location 21 DREAM LAKE RD . o 1A_ Owner POWERS , JUDY LYNN By Order of Town Board TAX MAP NO. 50. -1-24. 2 TOWN OF QUEENSBURY Director of Building & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY VALUE $ 0 ; Nu., TAX HAP NO 50. 1-24. 2 WARREN COUNTY, NEW PORK PERMISSION is hereby granted to POWERS. J_UDY LYNN OWNER of property located at 11 DREAM LAKE RD- Street,Road or Ave. in the Town of Oueensbury,To Construct or place a SEPTir ALTEPIPCTOF 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 „ 11 DREAM LAKE ROAD SO. QUEENSBURY NY 12804 2. CONTRACTOR or BUILDERS Name BATEASE . GLENN - 3. CONTRACTOR or BUILDERS Address • 46,ADREAHLAKIL. gr.. QUEENSBUR114EN.4.011K, .12804 4. ARCHITECT'S Name 5. ARCHITECTS Address 6. TYPE of Construction—(Please indicate by X) . SEPTIC /Wood Frame ( I Masonry Steel ( I 7. PLANS and Specifications SEPTIC -ALTERATION.AS PERT PLOT PLAN SPEC IPICATIONS 8. Proposed Use igaL'SEETIMailiT ° $ PERMIT FEE PAID — HIS PERMIT EXPIRES (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Oueensbury before the expiration date.) Dated at the Town of Queensbury this Day of , 19 1 !- SIGNED BY for the Town of Queensbury Building and Zoning Inspector. i Application for SEPTIC DISPOSAL PERMIT Town of Queensbury 77OO Dept. of Community Development Permit No.� Building &Codes Office �� 742 Bay Road Fee Paid $(yam'5, Queensbury, NY 12804 - ' , Location of property for installation: / I treaty\ lake- rf a . , Property Owner's Name: C. n r\ --v.. Cr Property Owner's Mailing Address: 1 k. `b-c-erk cr.k p r i 60 (h ij Ay B Z& Fil----;,—/-19,.- �, /� /717/--P6 Phone # 7 9 2 7 7S`- 7 ,. Installer's Name: F. � // Number of bedrooms (if residen ' )' '3 -- Total daily flow: .7 (:) (residential - compute @ 150 gal./bdrm.) Topography: flat, rolling, steep slope % of slope t- � r,-- Soil Nature: sand, loam, clay, other I.depth: Y p��tip NOV 21 1997 Ground water: at what depth? 4-''f et / Bedrock or Impervious Material: at what depth? _feet 1 TOWih 33 .2,;.i :.._!,;.:_ URY Percolation test: not required, required [rate ‘ min. per inch-19�!f-CM `i'` C2P Domestic water supply: municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is /TO feet. PROPOSED SYSTEM • Septic tank: I h lion (minimum size: 1,000 gal.) Tile field: each trench I'J1)"" feet / Total system length: feet Seepage pit(s): number of 4.--) / size each: y ft. by ft. Size of stone to be used: # 2 / depth or thickness feet HOLDING TANK SYSTEM: (if required) _ Number of tanks: t' Size of each: gallons CA1a1m system and associated electrical work to be inspected by a certified agency.J For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation 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 Queensbury Sanitary Sewage Disposal Ordinanc . Signature of responsible person: ( ti - bl� Date: 1.\.\Zi 1�j-1 TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name Phietri Location �� Date 2 Permit # 91)-700 SOIL-TYPE: Sand-Loam-Clay- Results of Perc•lati• est- (if applicable) 'at- to/Inch TYPE OF SYSTEM: ABSORPTION FIELD: ► . -ngth Length of each tre ch 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: m4 1-- 0 (76—/-Z- SYSTEM USE APPROVED: YES NO Arrived: W! Departed: Building Inspector • TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name ;;;Location - ' ,>. . Le , S_ Date r// / Permit # - (X) SOIL TYPE: Sand-Loam-Clay- Results of Per6lati • Te• t- (if applicable) 'atr-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: ' otal ength Length of each t ench Depth of trench:s 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: soy ar b ,--62÷/452e.; SYSTEM USE APPROVED: YES . NO Arrived: 6760 Departed: Building Inspector TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury WY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name gvo�3 Location — re/s-- Zdk Date Z/ Permit # R-7_700 SOIL TYPE: Sans-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inchiy— TYPE OF SYSTEM: ABSORPTIO4 FIELD: Tot Leng h Length of ach trenc Depth of tr ches Size of stone SEEPAGE PITS: m - 2 Size - ft. x ft. Stone size 2 PIPIN • ,,Size Type Bldg. to Tank eto Tank to Dist. Box —_,— Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank &64.. feet Foundation to Absorption 70 feet Separation of Pits ;2 ' ,_,-et / &— Conforms as per Plot Plan 'No LOCATION OF SYSTEM ON PROPERTY. (circle one) • Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: - ;' rc ,fir/ 5 , (U /ys-/,, sde f, 35 c SYSTEM USE APPROVED: ES NO Arrived: e/54 Departed: Building Inspector TOWN OF QUEENSBURY BUILDING 'A CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name (—itjerf Locatio (--;In,,, LE o/. Date / 146 Permit # .7 -70 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: Numb 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 COPM9ENTS:f /J�/Lf Gdv- le I U•R/ael /(/G'1, l is 5 /,, : SYSTEM USE APPROVED: YES NO Arrived: 2/XS - Departed: Building Inspector . , 7.... -77-------------7-- 31YG . AC:1 Gil Ak3.1A3li . , I . , r: --, -..--;, ›. ,-, fr's..;N.5 li al t, 1 44'7"t.,:6 .,.,7";v4.';,..:. ,g," cl) .....,•1 ,.,1 b - I, 0 i''l AA 0 1 .:. fJari9 VII)I (r) , ,.....- . .r, . 1 (-300 clivor..,-)moltne - i , s 1661 I g AON 113'1 s. . 1 . . sav"is .... l , ,' gi i C 7 . ' ) 1--2.... Of••TILL.\_.4: . 1-- •" ; . . • 1 '•'i 4. .4cji''0 . . .. .. ::1 ir4. .-telaii 3 1-0 • ,., ,,,,,,A01 , liVe, Ii Ii i,p: . . -.- .c:- fig 1_ ,,, rl.',1'.41.... :'• •..f-:-:is“..: A• j '' t yli7filw ' L L661. 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