2010-552 Moki TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100552 Date Issued: Wednesday, November 23, 2011
This is to certify that work requested to be done as shown by Permit Number P20100552
has been completed.
Tax Map Number: 523400-227-013-0002-039-000-0000
Location: 90 ROCKHURST Rd
Owner: LARRY CLEVELAND
Applicant: LARRY CLEVELAND
This structure may be occupied as a:
Test Pit/Perc Test Review
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the 1 f , /1
property owner of the responsibility for compliance with Site Plan, .44
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100552 Application Number: A20100552
Tax Map No: 523400-227-013-0002-039-000-0000
Permission is hereby granted to: LARRY CLEVELAND
For property located at: 90 ROCKHURST Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with 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. Type of Construction Value
Owner Address: LARRY CLEVELAND Test Pit/Perc Test Review
JOHN SHINE Total Value
32 NORTHWAY Ln
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2010-552
deep hole/perc test
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 23,2012
(If 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.)
Dated at the Towik,of Quersbury; f,`W day,November 23, 2011
SIGNED BY / r' . ' x for the Town of Queensbury.
Director of Building&Co e Enforcement
Town of Queensbury• Building&Codes Enforcement Office■742 Bay Road■
Queensbury,NYAIB41 �
DEEP HOLE/PERC TEST
Request for Town Engineer Review, No' 2 2 2010
F QUEEN L `°
Property Owner: --/0471 5 Phone:
Property Owner's
Address: /6 O Ve(/Go/c
Location of Test: gel ,+'c G/l ALi lej f Tax ID it: 277/3 '—Z /
*Applicant's Engineer: AI4-(ijjyfl,r�Z.e r Phone:
Applicant's Agent: a (''e,4 y Phone: 7'/o
('�
Additional Notes: /*CS1�ir .J'�r f��71C dei y/1 `"' 5 207,G 1/;/,3,o,,,,e L41A1/ E'
1. Reason for Request? New Septic System i><1 Replacement Septic System Failed Septic System
Subdivision r- Site Plan Review
2.Are Wetlands present? YES NO UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the system. The Town
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
FEE SCHEDULE:
a. $200 Flat Fee Date Paid:
Check No.:
b. • - Fee to be determined during To Be Determine .
to Plan/Subdivision review process ,.
ATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per own •f Queensbury .cal Law 136-14D.
ip � /
SIGNATURE OF APPLICANT: Date: ////f/A1
SIGNATURE OF AGENT: ite44 _ Date: //2 7A
Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
1 MAP REFERENCES 3
MAP OF A SURVEY OF A PARCEL OF LAND MAP OF
TO BE CONVEYED TO Dr. ABRAMS, BEING ROCKHURST ON LAKE GEORGE
THE SOUTHERLY PORTION OF LOT 25 OF DEVELOPED BY
THE HOW -MAC DEVELOPMENT ON ROCKHURST, HOW -MAC DEVELOPMENTS, INC.
SITUATE IN THE TOWN OF QUEENSBURY, DATED: DECEMBER 20, 1955
WARREN COUNTY, N.Y. LAST REVISED: JANUARY 24, 1956
BY. JOHN B. VAN DUSEN BY.• LESLIE W. COULTER
2 4
MAP OF PREMISES CONVEYED BY ROBERT A. ABRAHAM MAP OFA SURVEY OF A PARCEL OF LAND TO BE
TO ANTHONY COVIELLO & MARGARET, HIS WIFE CONVEYED TO DR. ABRAHAM
5
MAP OF A SURVEY MADE FOR
TONY DIBELLA
BY. VAN DUSEN & STEVES
DATED: APRIL 17, 2003
LAST REVISED: JUNE 18, 2003
BY. JOHN B. VAN DUSEN BY.• JOHN B. VAN DUSEN cB
RIM -336.2t
DATED: JULY 17, 1970 DATED: JUNE 25, 1968 ? j
335
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Land Surveyors
169 Haviland Road Queensbury, New York 12804
'UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY
MAP BEARING A LICENSED LAND SURVEYORS SEAL IS A
VIOLATON OF SECTION 7209. SUB -DIVISION 2. OF THE
NEW YORK SAE EUCATOLAW'
ONLY COPIES TE ORIGINALOF SURVEY
MARKED MIN AN ORIGINAL OF THELAND SURYEYDSS
SEK SHALL BE CONSIDERED ro BE VALID 1RUE COPES'
'CERTFICAT1ONS INDICATED IEREOI WMFY THAT
THIS SURVEY WAS PREPARED N ACCORDANCE NTH TIE
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`°"`SURVEYORS "°°°'E°
BT TIE NEW YORK STATE ASSOCIATIONCE PROFESSIONAL
LAND SURVEYOR& SAID MVICATONS SHALL RUIN ONLY
TO THE PERSON FOR VIRION THE SWAY IS PREPARED. AND
ON HISBEMM: ro DE TTE COiANY. GOVERNMENTAL
AGENCYTEs LENDINGOF NS111U,1a1 usEO mL' AID
ro THE ASSIpEES OF TIE LEIDIIIP gSIT1UTIOL'
518) 792-8474
New York
Lic. No. 50135
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Map of a Survey made for
John R. Shine
Larry J. Cleveland 2 10/19/10
Town of Queenslury, Warren County, New York 1
H9/23/10
N0. DATE
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