RC-000674-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000674-2016
Tax Map No: 301.15-1-58
Permission is hereby granted to: FOOTHILLS BUILDERS,LLC
For property located at: 32 ELK RIDGE DR
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
Tvceof Construction
Owner Name: FOOTHILLS BUILDERS,LLC Single Family-New $160,000.00
Owner Address: 9 Mountainside DR Total Value $160,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
FOOTHILLS BUILDERS,LLC
9 Mountainside DR
Queensbury,NY 12804
Plans&Specifications
Single Family Dwelling w/FP 1605 s.f.
Garage 528 s.f.
Lot 8
$1,300.20 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,October 12,2017
(Ifa 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 Town of eensb /J ,tfor
12,2016
SIGNED Ln
the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Date: 9130 /16 Permit No. Zc- to - 20 I
Tax Map ID so 1. I S S-8 Permit Fee 14150, 20
Zone MDR Historic? _Yes a_�_No Rec Fee I S%D
Siis-Plan'#���tt, lllt5
Subdivision Name E k Rt D G S D 9- Lot# 8 Subdivision#
Project Location 32- 91-K RID&-G DQ
TOWN BD.RESOLUTION 86-2013: $850 recreation fee for new dwelling units—single family,duplexes/two-family,multiple family,
apartments,condominiums,townhouses,and/or manufactured&modular homes,but not mobile homes. This is in addition to the
permit feels).
Primary Owner(s)
E0011411.1,5 $uILD(r25 LLL
Address
q rhour.>TAIN Sfpt` 1) R_ a6l N LBO
Phone/Email S l 6) l`�(0 3 S L o
506'TNILLS13ult-DBRSN @GIYIAIL• C.om
Applicant
SAS
Address
Phone/Email S fl1 -4r
Contractor
S Amt
Address
Phone/Email S A tr,it
Contact Person for Building& Codes Compliance: 30IS Le kc I Phoner 1 S) -79 b-3 SL
TYPE OF CONSTRUCTION
,/Check all that apply New Addition Alteration 1"floor sf 2"d floor sf Total sf Height
Single Family ✓ 6 0 S 140 C 20 {
Two-Family
Multi-Family
(#of units_)
Townhouse EP ? 0 201
Business Office
Retail-Mercantile
Factory-Industrial
Attached Garage
(1,93, 4+) S 2E3 S Z�
Other
Town of Queensbury Building&Codes Principal Structure Application revised January 2016
If commercial or industrial please indicate name of business
Proposed use of building or addition
Source of Heat(circle one) Gas Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances &Chimneys
Are there structures not shown on plot plan?
Are there easements on the property?
Site Information:
a. Dimensions or acreage of lot
b. Is this a corner lot? _Yes _No
c. Will the grade be changed as a result of construction _Yes _No
d. Public water or Private well(circle one) Public Private
e. Sewer or Private Septic System(circle one) Sewer Private
Value of all work to be performed (labor or materials) $ lkon o t)
DECLARATION.-
1. 1 acknowledge no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval.
3. I certify that the application, plans and supporting materials are a true and complete statement /
description of the work proposed, that all work will be performed in accordance with the NYS
Building Codes,local building laws and ordinances,and in conformance with local zoning regulations
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate
of occupancy.
5. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of
all newly constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: 6�S,EfP N l/l=��t i DATE: _11301(j6
SIGNATURE: CANI �Il DATE: 3� b
V
For office use only
Operating Permit Issued: _Yes —No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016
Fuel Burning Appliance & Chimney Application Office use only
Received
DATE: 9 1301R. Tax Map ID
TAx MAP ID: 36 (. 16-- i - S 8 Permit No.
Permit Fee
ZONE: M b 2
Foo-IH(usguu.DER5a1@CMA I L,CclM
OWNER 001llILLS ttilLD€RS L PHONE/E-MAIL �l8)� b"3S2a
ADDRESS MakuZgtN Slbe AR•
INSTALLER/ F'oo T H I LLS 6Iti L L0 LrKJ I.E,C PHONE/E-MAIL
5>9 m1s'
BUILDER
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: (rot-1 N ILLS 8w I LD E¢S N'1 ed G.IrI M I L• Lo M
PHONE/E-MAIL _ SoLr („ v= t-1 Ccls)-)iy3s-P BUILDINGADDRESS 32. ELti< R10a•Lr p9,,
ROOM OF INSTALL: CrR E NT P-6 a r1 PLANNED INSTALL DATE: 'AEI_• ZA 1 I
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN&
STOVE FINAL INSPECTION ARE
FIREPLACE INSERT ✓ REQUIRED.
FIREPLACE,FACTORY BUILT* NOTE:
MANUFACTURER'S
FIREPLACE,MASONRY
INSTALLATION MANUAL
FURNACE(GARAGE ONLY)
MUST BE AVAILABLE AT
TIME OF INSPECTION
*If factory built provide manufacturer name: Model#:
Listed by: Number:
CHIMNEY INFORMATION
Masonry** (check one) BLOCK —BRICK STONE
Flue TIE ✓STEEL Size in inches
Material _DOUBLE WALL _TRIPLE WALL _INSULATED
** If non-masonry provide manufacturer name: ;Model#:
DECLARATION: Construction/installation must conform to NYS Fire Prevention & Building Code and/or
manufacturer requirements. The applicant or owner agrees to comply with all applicable laws, ordinances,
regulations,and all conditions that are part of these requirements and also will allow inspector's to enter premises
to perform required inspections.
I HAVE READ AND AGREE TO THE ABOVE:
PRINT NAME: _j0 S F,?0 t&vl DATE: 3 6 (b
SIGNATURE: Com. D VL DATE: q 3a
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016
SEPTIC DISPOSAL APPLICATIION Office Use Only
Received
DATE: 30 (0, Tax Map ID
TAx MAP ID: 361. ) S-- I _ S-S Permit No.
ZONE: MA R Permit Fee
Cot.THILLS 9k(Lo 8'9ZN 6rn4&,&6W\
APPLICANT FooTRILLS gutLDtrQS U.C. PHONE/E-MAIL CrtB 6'SSZa
ADDRESS ij MbwNiglNS(plr D(Z U�CNSgu2 N`I l2Qo
INSTALLER/ f PHONE/E-MAIL
BUILDER r001({IUS t3klLDLRJ LLC S %+�Lr
OWNER 5 A rvL,E
ADDRESS S P,rA.Lr
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: Jo r Le N.L-
PHONE/E-MAILx5*18) -11(,-3S1A Foo?NILLS guILDCAZN-j@ (,.rn4 L G6&\
RESIDENCE INFORMATION
Year Built #of bedrooms X gallons per bedroom =total Daily flow
1980 or older Garbage grinder installed —Yes X No
1981-1991 Spa or Hot Tub installed Yes �No
1992-Present 3 I(0 3 3 U
PARCEL INFORMATION
Topography Flat rolling Steep slope %Slope
Soil Nature _,X Sand _Loam _Clay _Other
Groundwater At what depth: N l A
Bedrock/Impervious material At what depth: N 1 SP1
Domestic Water Supply _X Municipal Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: 1- T per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank sizeej °o gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub
System Absorption field with#2 stone Total length__L�Ec ft.;Each Trench_S7'0
Seepage Pit with 93 stone How many: _;Size
Alternative System Bed or other type:
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will
no longer allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the
septic system layout on file-no exceptions.
Declaration: Any permit or approval granted which is based upon or is granted in reliance upon any material representation 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 and agree to
abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
PRINT NAME: 03 L- P Il (,E i.t C-I DATE: 1 S G 4(-L
SIGNATURE: DATE:
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016
Town of Queensbury Thomas R. Van Ness
Highway Department Highway Superintendent
742 Bay Road, Queensbury,NY 12804 Home: 518-745-0929
Phone: 518-761-8211
Fax: 518-745-4466 David Duell
Deputy Highway Superintendent
Home: 518-745-0938
DRIVEWAY PERMIT
Date: ho (l b
Applicant Name: Foa7lilUs 6tilt-Uf-AS
Telephone No.: ( S(6) l 9 6 - 3 r2 c
Address to be Inspected 32- EL IL DA.
Return Address: 9 Mo wN z A i WS I p r DR-
001 ti`t r286`f
Applicant must show exact location and width of driveway(s)to be connected to the highway by placing stakes
at the specified location
The Superintendent of Highways of the Town of Queensbury has reviewed this application. The following action
has been taken:
STEP 1: ( ) Preliminary approval
NEED ( ) Slight Swale
( ) Deep Swale
( ) Level with the road
( ) Level with the top of the paved wing
Size culvert pipe to be used(if necessary)
( ) 12" ( ) 15" ( ) 18" ( ) 24" ( ) 36"
Preliminary inspection completed by: Date:
Approval by Highway Supt.: or Deputy Supt.:
Upon completion please resubmit this approval permit for a final approval.
STEP 2: ( ) Final Approval ( ) Rejected
Date:
Thomas R. Van Ness, Highway Superintendent David Duell, Deputy Highway Superintendent
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016
301.15-1-58 RC-000674-2016
y�► W Foothills Builders
shutwater
off 3(f� q water 32 Elk Ridge Dr., Lot 8
E shut off
� W
LEGEND sFD w/FP 1605 s.f., Garage 528 s.f.
lzl� IRF IRON ROD FOUND
IPF IRON PIPE FOUND
IRS IRON ROD SET
10� UTILITY POLE
CDCDC> STONE WALL
x WIRE FENCE
o CHAIN LINK FENCE
LOT 7 11 WOOD FENCE
r
I, C POINT
moo.
1.1a o a F.P. FENCE POST
ON r, o 0 0° ohw— OVERHEAD WIRES
}+p n ��js �s
�y C) O water
26.6' / y�ycoy�O shut off a n/f NOW OR FORMERLY
O
.� catch basin ❑ oyQ *',
62 21 �p rim elev!� ►Y 8
=480.4' catch basin -A water '
rim elev. shut off t
\pR� �=480.4'
Y hydrant
CBPG\,-/ s) 2 to
Lands n f oG Sri FPROPOSED OUNDATION shut off MAP REFERENCE. J^
�✓ �J���j 26 4 1) "MAP OF A SUBDIVISION OF LAND MADE FOR FOOTHILLS BUILDERS LLC"
Jennifer P. Rowley S�J� i ° DATED 10/03/14, PREPARED BY BOLSTER AND ASSOCIATES PROFESSIONAL
& Andrew J. Cartie 2`' �� 6°S�P�� / LAND SURVEYORS.
L. 4518 P. 038
NOTES: w
1) BASE MAP PREPARED FROM A JANUARY 2014 FIELD SURVEY.
Li
4
- LOT h� 2) NORTH ORIENTATION IS BASED ON MAP REFERENCE 1.
%n m I A ® J�j �� 3) THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT F4
� n +� +� �� LOT 9 OF TITLE AND IS THEREFORE SUBJECT TO ANY EASEMENTS, COVENANTS J
LU
z Co L 0.85 ACMES ��j 1168 OR WOULDSDISCLOSE. OF RECORD ANY STATEMENT OF FACTS SUCH DOCUMENT
Q
ZJy fence 30' REAR BUILDING 4) SUBJECT TO APPLICABLE LAWS AND APPROVALS OF THE TOWN, COUNTY, AND STATE
ti O SETBACK REGARDING DEVELOPMENT OF LAND.
y00
5) UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND
N84'44'Ol"�y SURVEYORS SEAL IS A VIOLATION OF SECTION 72.09, SUB—DIVISION 2, OF THE
shed 154.05'
NEW YORK STATE EDUCATION LAW.
'
6) ONLY COPIES FROM THE CRIGINAL OF THIS SURVEY MARKED WITH AP! ORIGINAL OF THE
LAND SURVEYORS SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES.
7) UNDERGROUND UTILITIES, STRUCTURES AND FACILITIES HAVE BEEN SHOWN FROM.
PERMIT I'!,,O ;'!_ SURFACE LOCATIONS AND MEASUREMENTS OBTAINED FROM A FIELD SURVEY.
Lands n/f THERE MAY BE OTHER UTILITIES WHICH THE EXISTENCE OF ARE NOT KNOWN. SIZE,
I HAVE PERSTgALLY MEASKGD CT
Carol Mosher i TYPE AND LOCATION OF ALL UTILITIES AND STRUCTURES MUST BE VERIFIED BY
C \ �,., PROPER AUTHORITIES PRIOR TO ANY AND ALL CONSTRUCTION. CALL DIG SAFE PRIOR
L. 714 P. 258 FROM THE P..O �, Y !�i ;_ To ANY EXCAVATION.
P POSED �T; U,P�� is I`�!Vl�i
PLOT PLAN MADE FOR
,., 'tJF�TURE Gr';TE �n r �n p � �`'
Of T F®®l �l LLS BUILDERS�3 L.L AC
lJ4ETTF
GRAPHIC SCALE �`yy
50 0 25 50 100 200
Cr. :.-. .�,: Town of Queensbury County of Warren State of New York
RUSSELL E. HOWARD
( ) 05054" LlCENVSRD LAND SURVEYING
IN FEET
� ' 342 Main Street, Hudson Falls, New York 12839
1 inch = 50 ft. Russe �zuard, PLS N.Y.S. Lic. No. 50540 Date: 9/30/16 Sheet 01 of 01
Date Sealed: t�� G Scale: 1 inch = 50 feet Revised: Drawing #r:13074L8PP
CERTIFICATION.-
I HEREBY CERTIFY TO: �' q water
shit off LEGEND 1) FOOTHILLS BUILDERS LLC �'
9--(-- (D _-�zj - zoite
THAT THIS MAP WAS PREPARED FROM AN ACTUAL FIELD
SURVEY COMPLETED UNDER MY DIRECT SUPERVISION. (� IRF IRON ROD FOUND
THIS SURVEY AND THE CERTIFICATIONS HEREON SHALL BE (1 IPF IRON PIPE FOUND !� f1 n,7 f�
VALID ONLY TO THE PARTY OR PARTIES HEREON NAMED AND �I IRS IRON ROD SET L tJ L. LS
ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR 10� UTILITY POLE
SUBSEQUENT OWNERS, OTHER THAN AS MAY BE OR EXPRESSLY oC;o STONE WALL
STATED HERE Nx WIRE FENCE
o CHAIN LINK FENCE
1 0 — WOOD FENCE
LOT 7 ; o POINT TOWN OF QUECNStJR`(
RUSSELL E. HOWARD NYSPLS## 050540 26.6' II
o D F.P. FENCE POST BUILDING & CODES
DATE: 12/14/16 ^ p o o s�
1 a onw— OVERHEAD WIRES
o. 00
`4 n/f NOW OR FORMERLY
03
catch basin a yQ
o +`'
Fj2 21vn2 oZ rim elev!� n
=480.4' catch basin
rim elev.
\ =480.4' y hydrantPOURED
t a�
o"'G FOUNDATION / MAP REFERENCE.
Lands n
/f gv��� 1) "MAP OF A SUBDIVISION OF LAND MADE FOR FOOTHILLS BUILDERS LLC"
Jennifer P. Rowley SOF DATED 10/03/14, PREPARED BY BOLSTER AND ASSOCIATES PROFESSIONAL -; U
& Andrew J. Cartie z5 LAND SURVEYORS.
L. 4518 P. 038 26.4'
NOTES: ; w
m� LOT 8 1) BASE MAP PREPARED FROM A DECEMBER 2016 FIELD SURVEY.
92 0ARE _ �����G� ��� 2) NORTH ORIENTATION IS BASED ON MAP REFERENCE 1.
�.8�� �I�RJ�1J O�?� � �� 3) THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT C4
N to U-) � m J`7 LOT 9 OF TITLE AND IS THEREFORE SUBJECT TO ANY EASEMENTS, COVENANTS aw
�^N C 0 117.0' OR RESTRICTIONS OF RECORD ANY STATEMENT OF FACTS SUCH DOCUMENT
ZLO 00 L �/ WOULD DISCLOSE.
30' REAR 4) SUBJECT TO APPLICABLE LAWS AND APPROVALS OF THE TOWN, COUNTY, AND STATE
C3 fence BUILDING SETBACK REGARDING DEVELOPMENT OF LAND.
CO
�v0
5) UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND
N84'44'01"W SURVEYORS SEAL IS A VIOLATION OF SECTION 7209, SUB—DIVISION 2, OF THE
shed 154.05' NEW YORK STATE EDUCATION LAW.
fJy 6) ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED WITH AN ORIGINAL OF THE
LAND SURVEYORS SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES.
s
7) UNDERGROUND UTILITIES, STRUCTURES AND FACILITIES HAVE BEEN SHOWN FROM
SURFACE LOCATIONS AND MEASUREMENTS OBTAINED FROM A FIELD SURVEY.
Lands n�f THERE MAY BE OTHER UTILITIES WHICH THE EXISTENCE OF ARE NOT KNOWN. SIZE,
Carol Mosher TYPE AND LOCATION OF ALL UTILITIES AND STRUCTURES MUST BE VERIFIED BY
PROPER. AUTHORITIES PRIOR TO ANY AND ALL CONSTRUCTION. CALL DIG SAFE PRIOR
L. 714 P. .258 TO ANY EXCAVATION.
�F NEN r MAP OF A SURVEY MADE FOR FIN L z)URVEY
'< N,ME7TF O
co ya 9� A'®TRILLS BUILDERS LLC
GRAPHIC SCALE
50 0 25 50 100 200 'i ;.; . T; Town of Queensbury County of Warren State of New York
maw
FO o� ��SJQJ RUSSELL E.
fIOKARD
IN FEET ) LAND LICENSED LAND SURVEYING
342 Main Street, Hudson Falls, New York 12839
1 inch = 50 ft. Russell E. Howard, PLS N.Y.S. Lic. No. 50540 Date: 12/14/16 Sheet 01 of O1
Date Sealed:/ /y �GScale: 1 inch, = 50 feet Revised: Drawing #:13074L8F
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury,NY 12804
Phone-518-745-4400 Fax -518-792-8511
June 8,2017
Job#46262
Dave Hatin
Town of Queensbury Building Department
Bay Road
Queensbury,NY 12804
RE: Leuci Peggy Ann Road Subdivision- Queensbury(T)
Lot# 8 Septic System
Dear Dave:
This letter is to inform you that we inspected the completed septic system for the house at Lot#8
in the Leuci Peggy Ann Road Subdivision on June 7, 2017.
The septic system as installed was for a three bedroom house and consisted of a 1,000 gallon
septic tank and 150 lineal feet of absorption trench constructed with stone and perforated pipe.
The system conforms to the requirements of the approved subdivision design drawings.
Please call me if you have any questions or concerns.
Sincerely,
Thomas R. Center Jr., PE
JUL 3 1 2017
water
�j
shut off L1L/ GEAID
IRF IRON ROD FOUND
IPF IRON PIPE FOUND
IRS IRON ROD SET
`U3 UTILITY POLE
oCDC:) STONE WALL
\ X— WIRE FENCE
o — CHAIN LINK FENCE
LOT 7 o — WOOD FENCE
II o POINT �.
26.6' 111 o a F.P. FENCE POST
0 0 0 ohw— OVERHEAD WIRES
9
F�mGo n/f NOW OR FORMERLY
0 v/
IO
1 p catch basin
Nk rim etev� ° p
=480.4' catch basin
�rim etev. J
=480.4' h rant �
1.7. ,s✓j4� 3�
y
/ .2' NAP REFERENCE:
Lands n f 41.3' 1) "MAP OF A SUBDIVISION OF LAND MADE FOR FOOTHILLS BUILDERS LLC"
Jennifer P. RowleyG DATED 10/03/14, PREPARED BY BOLSTER AND ASSOCIATES PROFESSIONAL V
& Andrew J. Cartie ��N / LAND SURVEYORS.
L. 4518 P. 038 oEg / 26.4
DISTRIBUTION BOX 17.2 1,000 GAL W
SEPTIC TANK NOTES:
LOT (91) BASE MAP PREPARED FROM A DECEMBER 2016 FIELD SURVEY.
AREA
�A 2) NORTH ORIENTATION IS BASED ON MAP REFERENCE 1.
CD�� =I ®o(953.* ACIMS \�j �� 3) THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT 94
LO LOT 9 OF TITLE AND IS THEREFORE SUBJECT TO ANY EASEMENTS, COVENANTS w
ap 0J 117LO Go .0' ABSORPTION OR RESTRICTIONS OF RECORD ANY STATEMENT OF FACTS SUCH DOCUMENT 0.'
0.
z it L `� 3 ®50' EA TRENCHES 7 ;.- WOULD DISCLOSE.
y fence 30' REAR BUILDING SETHgt;K _` 4 SUBJECT TO APPLICABLE LAWS AND APPROVALS OF THE TOWN, COUNTY, AND STATE
O
REGARDING DEVELOPMENT OF LAND.
NC
-4 \ 5� UNAUTHORIZED ALTERA710N OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND
'ti,a N84'44701"W \ j SURVEYORS SEAL IS A VIOLATION OF SECTION 7209, SUB—DIVISION 2, OF THE
shed NEW YORK STATE EDUCATION LAW.
154.05' ,
6) ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED WITH AN ORIGINAL OF THE
�) LAND SURVEYORS SEAL SHALL BE CONSIDERED TO-BE VALID TRUE COPIES.
Lands n/f
Carol Mosher — �� 7) UNDERGROUND UTILITIES, STRUCTURES AND FACILITIES HAVE BEEN SHOWN FROM
�' SURFACE LOCATIONS AND MEASUREMENTS OBTAINED FROM A FIELD SURVEY.
L. 714 P. 258 GRAPHIC SCALE
� .' O a THERE MAY BE OTHER UTILITIES WHICH THE EXISTENCE OF ARE NOT KNOWN. SIZE,
TYPE AND LOCATION OF ALL UTILITIES AND STRUCTURES MUST BE VERIFIED BY
50 0 25 50 100 200 4 - ''6 ' PROPER AUTHORITIES PRIOR TO ANY AND ALL CONSTRUCTION. CALL DIG SAFE PRIOR
TO ANY EXCAVATION.
( W FEET ) 'HAP OF F
A SURVEY MADE OR
�S"
I inch = 50 ft. 00 HI BU M9121 I J.fW
Town of Queensbury County of Warren State of New York
SEPTIC SYSTEM AS BUILT BY NAGE ENGI EERCU G 9 JWAM
8v1WIi'!lM
b/0 2 0 ¶ 342 Main Street, Hudson Fails, New York 12839
1L Russell E. Howard, PLS N.Y.S. Lic. No. 50540 Date. 12/14/16 Sheet O1 of 01
Date Sealed: Scale: 1 inch = 50 feet Revised: Drawing #:13074LBF
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit NJ�—..(0'44T
.1.\Q.Cert-N0 Cut-in Card No.....................................
GG —Owner......... .4.........................OiM ...................................................................
........................ ..........
Location...32... ......Die................*** ..Cl�..
Installation Consisting Z-./-1"'.5 ..............
0 .............................................................
....................................................................................................................................................................................
InstalledBy...... 7- .7.,41....................................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of makinF.Ain7ctions at any time, and if its
e
V ..........................
te
rules are violated,the Company shall have the right to r this^011110a
Date.......q-l-!5*^. ............
...............17. INSPECTOR....
Member N.F.P.A.,I.A.E.I.