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1999-158 CERTIFICATE Off! COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK April 21 99 Date 19 99158 This is to certify that work requested to be done as shown by Permit No. has been completed. SEPTIC ALTERATON , This structure may be used as a Location 1231 BAY RD. -- Owner ELLSWORTH, MARIE TAX MAP NO. 28 . -1-33 By Order of Town Board TOWN OF QUEEN U Y Director of Building & Code Enforcement • BUILDING PERMIT VALUE $ 0 TOWN OF QUEENSBURY No. 99158 TAX MAP NO. 28. —1-33 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to ELLSWORTH. MARIE OWNER of property located at 1231 BAY RD. Street,Road or Ave. in the Town of Queensbury,To Construct or place a SEPTIC ALTERATON 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. OWNERS Address is 1231 BAY RD. LAKE GEORGE, NY 12845 2. CONTRACTOR or BUILDER'S Name CONDON'S SEPTIC & DRAIN SER. 3. CONTRACTOR or BUILDERS Address 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) SEPTIC )Wood Frame ( 1 Masonry ( )Steel 1 1 7. PLANS and Specifications SEllOrIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8. Proposed Use SEPTIC ALTERATON $ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES April 22 2001 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 Oueensbury before the expiration date.) Dated at the Town of Queensbury this 22Day of Apr 1 1 19 1999 SIGNED BY X� ` WIJ�e�.�. for the Town of Queensbury Building and Zoning Inspector l-1p}J111/4.rcLL.W11 1%.11 ►., J. 1J1/J1 VIJr1S_ .1 1;,i .1v111 I 1 Town of Queensbury Permit No. 99-15g Dept. of Community Development Building &Codes Office 742 Bay Road Fee Paid aS. ©7) Queensbury, NY 12804 Location of property for installation: IL 3 / Ay PT) Property Owner's Name: (cVED Property Owner's Mailing Address: 1)-3/ '"&9 y h rD. APR 1 9 1999 rovvi Installer's Name: V , I l�.��`�.4-) `44ch %U'c Phone # e __ uEEr,�,eu DE U Number of bedrooms (if residential): 2i Total daily flow: ZQa (residential - compute @ 150 gal./bdrm.) Topography: y flat, rolling, steep slope % of slope Soil Nature: sand, to clay, other /depth: Ground water: at what depth_ feet / Bedrock or Impervious Material: at what depth?/ feet Percolation test: not requir- required [rate min. per inch] Domestic water supply: municipal, X well, other If domestic water supply is a WELL, water supply from any septic absorption is j6 Q feet. PROPOSED SYSTEM Septic tank:lab gallon (minimum size: 1,000 gal.) Tile field: each trench 5/.0 feet / Total system length: Z 5 feet Seepage pit(s): number of / size each: ft. by ft. Size of stone to be used: # 2/ / depth or thickness feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each: gallons CA1m 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 Ordinance. Signature of responsible person O yl � Date: �` cL d " q ( Aft ' elaWorill .1-3 I 2YOY Al) -7(1.1.-1-6 3 aoobrv`i Kfstt'(:,4 ',AtZ/9(/v SFR , ivc._ v f I Ill, It' i .- - hie r Atic -7P,--efs-y)._ ..20( r s -2 rY ic-..--7- , , - APR 1 9 1999 , 6 a .SOWN OF QUEENSBURY lb — ,A,11pING AND CODE 1..‘t1 Lf. V ta. .. ............ .................. ........ ...............„,.... ..„ , [1 have seen or observed, or believe I saw evidence of, , !,I objects such as houses, wells,trees, fences, etc., I shown on tins document. I also represent that I have re personally measured the distances set forth on the diagram." rp, oe,44.„ SIGNATURE DATE S It(3 A t I/ ri ( ___ TOWN OF 0,LEENSBURY , t -CT' BUILDING & CODE , EPT. ' "" REVIEWED BY / , T i : , , T rieE ON DATE IMONINSMOW.M.ale _ , T E D ' " ATIOl. OF CONSTRUCTION _ A() -I '2 A fi (1,-,,rr 1 4-1. C - i S it, 1._11:_Le 1-i- pi A I J A-474