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98-567 - \, CERTIFICATE OF COMPLIANCE :TOWN OF QUEENSBURY - - WARREN COUNTY, NEW YORK Date September 25 19 98 98567 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 Location • • — 765 QUAKER RD. -- - . .- Owner COMMUNITY WORKSHOP, - INC, TAX MAP NO. - 110. -1-2, 3 By Order of Town Board - TOWN OF QUEENSBURY _ , , 0 Director of Building & Code Enforcement a. - BUILDING PEP MIS' VALUE 0 TOWN OF QUEENSBURY Na 9R5g7 TAX MAP NO. 110. -1-2. 3JVARREN COUNTY, NEW PORK PERMISSION is hereby granted to COMMUNITY wORKS1Op r TwJ OWNER of property located at 765 QUAKER RD- Street,Road or Ave. in the Town of Queensbury,To Construct or place a SEPTTC Ar TERATIQN 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. 1. OWNER'S Address is P.O. BOX 771 GLENS FALLS,NY 12801 2. CONTRACTOR or BUILDER'S Name ELMS, KEVIN 3. CONTRACTOR or BUILDER'S Address • 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) SEPTIC I Wood Frame ( I Masonry ( )Steel ( ) 7. PLANS and Specifications No. 8. Proposed Use SEPTIC ALTERATION 35 September 14 „2000 $ PERMIT FEE PAID -THIS PERMIT EXPIRES 19 (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 bafore the expiration date.) 14 September 1998 Dated at the Town of Queensbury is Day of 19 SIGNED BY for the Town of Queensbury Building and Zen ng nspector Application for SEPTIC DISPOSAL PERMIT Town of QueensburyCommunity Permit No. c 5l r„ Dept. of Development 1 � �� i-J , Building &Codes Office — 'c 742 Bay Road Fee Paid $35 Queensbury, NY 12804 Location of property for installation: 2's '% - ,(1412 Property Owner's Name: C, c.V, f e Property Owner's Mailing Address: ,4c9 /1 a , C Installer's Name: Phone # 79',( - ,2 'i i l er of-beds-eo if r-esidentinl): • Total daily flow: 9/e.c,v( (residential - compute @ 150 gal./bdrm.) Topography: 9( flat, rolling, steep slope % of slope Soil Nature: X' sand, loam, clay, other /depth: Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet Percolation test: not required, required [rate ®r z min. per inch j Domestic water supply: X municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. PROPOSED SYSTEM Septic tank:6/6T,,gallon (minimum size: 1,000 gal.) SEP )) 1995 Tile field: each trench 5/0 feet / Total system length: ,f'10 feet_ _ ,; Seepage pit(s): number of / size each: ft. by ft. Size of stone to be used: # 9 / depth or thickness / £ee ^ f`2c . t-.©,tom ��r/ � �G e�J �G�c c OR16/.v4-c � -�'� OA) a c.c, a- spc0, HOLD SYSTEM: (if required) Number of tanks: Size of each: gallons CAlarm system and associated electrical work 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 Queensbury, any permit or approval granted winch 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 Ordinance. Signature of responsible person: „. Date: -.f1r-7 1rfr-til v-+tv v,� i ly» )-;�14iarlct ' I it-+ti, ,41.110d 4i - _.. �-� r®1r 1-4f., l - -_- ,-_-- ',.t. ' i i ¢4:p2 +�1® e 1 .i 011-1 ( �) °�©+ f oeid -d, '-) -- vIk21� �.,U° 'r --- -id c ) 1-41w (.. ) s . L'-7)9 -C6 - " 17`, a ,p,,e,/•-lvv. a,i ), -. '6 (cis -tom ' ,, 4?"\ -1.N' wJ i % r L ) 'J ' *,,,N/'- -s.a) P ..1.vea r4031 ramy -.." t ►1 "rt,4 911,1 1 ::VINO r•+o1.►Ar:1, . '9(y ,)W $ � 1/ *1).. 4v I -� 'a°t ' • e I,a p1` 1-,,zt r%)-2ii47,4'1/43 `'c -0 'p\ 4 i7e., /` ' '`2 .I ° ' r1J1 z1 y � r = } . e • 1 . Y • s. . a -r+ rr.L. ��� ® _ I : '" � : (.4) . --1 � 1 --.,.1 , < - 9 ) °1 all7F1''''''''re Gem' i . 7 : s1' :l� .^0� .. , ,,,, _ _ ,, v) j \ Cs®t=1G p4o evj , 1 ::1 - . „� � 1- .} .- iA ` . ' ' t46 , FILE COPYI I , ... ir 1 • . / , • ,..1... \ , 1. SUN-0,EQUEENSBU.�RY BUILDING DEPARTNII4T - , r -� Based or our liin itedl exr minatiotlw �.. compliance�lith our con,mentsshad 1 ' , \ /'` - �'�( ��, not be construedas�ndi•sting the I . / I��. 1�LJ I Z plans and specifications are in full I •� v-\ 0 compliance with`the cod •a �' s\ 1 �� G a _.._. _I. .{-_-- _ ��'I o t2.._ __, J I i , ,ill \ •• ... ......._!......7.- -. 1-1,,, . . * X -cr,- '11. 4:4,k, pi .,'. -.I - • t 'sr..- i .e,:,. --) 1 5.1-r4-eistrk.ip-t; ' . .. ..c.,, ' . • ., i t 1Vs'•\\_>..:\ : 1,4%.(.• -.V1-: /3.,1 o 1 ••[ •._ • . • 1 • . , • . •. t' �' GIB { I 'irl�� �ir��ifi� Cis>1Pa � �i� ,4i ,t / k\ I a ' - 1 7 ... f� I pUh o'h!n\ t 2 )-7- ��clt : ing le.F t it t/- O•&147 0(e/1,019g I fog pteg I � Ltd ds f . • -- • ,; ; !tri. }-2,,\-/,,-4 e.',r - , 1>aJ, Z"S,'� i ��c� c�T/it/�1 �_, ,!o / C r) • — _ ( .. ,� 7 _ -7.-- - Ano t M46, 1 d,Q t C�t,n.J.i-c.- ��� fir, 6C0, 4• L.+�6 t'�''' r,, Gi'� ,- . ° �i _ - 7 r- r F �' --. - - — -w- _— -.,, .._- 143ve-seeA a-them ttf believe{ R Evidence VFj T f -;�--` -z .� -_- ,Y >p' '�a. i ,�_ all objects sucks ,weds;treed ices,etc., ui!i c, r r, ( ! - >.j, ;`{ ',a :4 : '` "ti shown on this document.l also represent that l have - c,� EP i 1998 personally measured the distances set forth on the diagram." � 3t i ✓ -i. ' .r. r 4,;Y§?FS�'!C�.. w � ea ° .��vr--ice . ��, / - tal A w —^ -- -- -DATEI? I- — _ - _ - .--. -- -- _ _ - - - .- -- _ _- - .^ -. - - -_ _ if, i' TOWN OF QUEENSBURY 314(-N-T- BUILDING & CODE ENFORCEMENT L 742 Bay Road N Queensbury NY 12804 (518) 761-8256 �r _____. SEPTIC DISPOSAL SYSTEM INSPECTION q-d-Cil.7/ Name „� L Location 67,446—Z Date - Permit # W- 66 SOIL TYPE: Sand-Loam Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: t ABSORPTION FIELD: Total Length 164) _ Length of each trench t 4 Depth of trenches , Size of stone I,_ 5 SEEPAGE PITS: Number- Size - f `. x / f . Stone size PIPING: Siz Type Bldg. to Tank c.-• wf/. ,` Tank to Dist. Bo *0 7e Dist. Box to Fi 1d/iiit Openings Seal d? No P rtial LOCATION/SE? RATION Foundati9 to Tank feet Foundation to Absorption ( feet Separation of Pits fe- Conforms as per Plot Plan Yes 'o LOCATION OF SYSTEM ON PROPERTY: (circle one) . - Front - Rear •_- - Right Side Middle Front • "e Rear CO ENTS: &,ivi.f 45. -6 0/67- /9IU 1 reik SYST EM USE APPROVED: YES 11! Arrived: ,,.-- Departed: " °., /3j Building Inspector TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury 12804 (518).U.1-825; SEPTIC DISPOSA /SYSTEM INSPECTION Name K Location — t R Date O Permi # q9 c& 7 SOIL TYPE: Sand-Lom-Clay- Results of Percolation Test- (if applicable) Rate7M ute/Inch TYPE OF SYSTEM: 1 ABSORPTION FIELD: Tote Length Length of each trench Depth of trenches ,,, A Size of stone 1 SEEPAGE PITS: Numb lk Size - ft. It ft. Stone size I. PIPING: Si 'e Type Bldg. to Tank t* Tank to Dist. Box , Dist. Box to Fielo/Pit Openings Sealed? t Yes No 1 arti al LOCATION/SEPARATEONS: Foundation to T. k eet Foundation to Ab,torption '-et Separation of Pits 'yet Conforms as pe 'Plot Plan — LOCATION OF Sr EM ON PROPERT (circle one) Front - Rear - :eft Side - Right Side Middle Front - iddle Rear COMMENTS: SYSTEM USE APPROVED: OJ Arrived: Departed- `,. . Bu' ding Inspecto I r -C-01-1-/v/T-7(1-r"----L.-jc--rv---r-c- 6c/O QQ/ 'WA- IL-7D' 793 , V/f° t -e4;- GiQAfor /40E - - lf I G)ogeiv_E e,d-y ivy P-eu Y 01 /71,5 rillS iii-yi / 1-8-0 ( . . . "I have seen or observed, or -believe I saw evidence of, . all obiects such as huuses, weds, trees, fences, etc., —I shown on this document. f &so represent that I have personally measured the distances set forth on the diagram." , ..3,,..._ . . u) ./.-- IGNA",RE DATE . 5C .. ,' C,,Ceit. 1—. 66 r. —1 ....,.., 3° -- \-5-4t)-- 60 vpuif g)( iSi /A1 i s , jEctioL.:04- i . i-- ( i 6--, t 66 ‘1 \lk0 DR / VP60AY 1 1 , , 7/1)441-AA7-0, Sys-tEm V RD