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96-421 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date •July 16 19 96 This is to certify that work requested to be done as shown by Permit No. 96421 has been completed. • This structure may be used as a SEPTIC ALTERATION Location 820 BAY RD. Owner LETIZIA, MICHAEL & By Order of Town Board TAX MAP NO. 60. -1-1 1 TOWN OF QU E BURY Director of Building & Code Enforcement BUILDING PERMIT VALUE $ 0 TOWN OF QUEENSBURY No 96421 TAX MAP NO. 60. -1-11 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to LETIZIA, MICHAEL & OWNER of property located at 820 BAY RD. Street,Road or Ave. in the Town of Queensbury,To Construct or place a SEPTIC ALTERATION 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 JOSEPHINE 820 BAY RD. QUEENSBURY, NY 12804 2. CONTRACTOR or BUILDER'S Name CONDON SEPTIC & DRAIN SERVICE 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) SEPTIC ( 1 Wood Frame ( 1 Masonry ( )Steel ( ) 7. PLANS and Specifications SEPTIC ALTERATION AS PER APPLICATION 8. Proposed Use SEPTIC ALTERATION $ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES July 12 19 98 (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 before the expiration date.) Dated at the Town of Queensbury this 12 of July 19 96 SIGNED BY for the Town of Queensbury Building and Zon Inspector Application for SEPTIC DISPOSAL PERMIT �1ui,A 't `�ED Location of property for installation: , r�{? y/�y PERMIT NUMBER Owner's Name: m t c /2 / r f — -0 9( - 4(Address: .R a j 4 AI- ( ' Installer's Name: L DYtl c k IL -� f'`'i1 --' ` FEE PAID Phone #: ( ) 79.6-_.gis--£.- )._ '.K 4 ';Number of bedrooms (if residential): Total daily flow (residential -compute @ 150 gal. per bedroom): 4/ O Topography: rAFlat nn Rolling [1 Steep Slope % of Slope Soil Nature: Nj Sand n Loam In Clay El Other /Depth: Ground Water: at what depth? /04 feet Bedrock or Impervious Material: at what depth? r /} feet Percolation Test: (<1 Not Required r1 Required/Rate min. per inch Domestic Water Supply: /I 1 Municipal 1X1 Well r-i Other If domestic water supply is a WELL: water supply from any septic absorption is feet PROPOSED SYSTEM: Septic tank: 1).--P gal. (minimum size: 1.000 gal.) Tile Field: each trench J ' feet. / total system length 2--9°1 feet. Seepage Pit(s): number of / size each: ft. x ft. '`7 Size of stone to he used: # '"---. / depth or thickness feet. HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each: gal. Alarm system and associated electrical work to be inspected by a certified agency. For your protection, please note that pursuant to Section 136-29 o f the Code o f 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 o f an applicant, shall be void. I have read the regulations with respect to this application and agree to abide by these and all requirements o f the Town of Queensbury Sanitary Sewage Disposal Ordinance. n _I' P6 Signature of responsible person: /.l 311./ Date: ale o 4:roe.ts ,;()A-\ TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name /L/,+-a-,4 a_ ,L 77 24 6 Location ? ) d Date ?// /q4- Permit # 9 SOIL TYPE: San -Loam- lay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length ;:Ge Length of eac trench rrr Depth of trench s ' -t-n Z` Size of stone Ir.. -Z SEEPAGE PITS: N m r- Size - - ft. Stone size- PIPING: Size Type Bldg. to nk 4t'4CM 4c -01XDPN3E Tank Dist. Box 4.150P, iwyN Dist. Box to Field it; tf Pv� - Openings Sealed? No Partial LOCATION/SEPARATION Foundation to Tank t- -7,6' feet Foundation to Absorption <2).Fc feet Separation of Pits feet Conforms as per Plot Plan Yes LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front CM1d le Rear COMMENTS: Yam' cif g ciR<t2 / Usc), SYSTEM USE AP ROV D: YES Arrived: �T Departed. Building In for Y PLOT PLAN SEPTIC SYSTEM Notice: The following statement must be "stamped" on your plot plan. This sheet of paper may be used for purposes of drawing your plot plan. After drawing such plot plan, mot, please read the statement and sign it. If you choose to use other paper for your plot plan, the office will stamp those plans for your signature. 0 \M !r 6... b-, 0- l 0 N'£w pis \ 000C 10V- \ 10C-W 41 C-' §EP —Tit 21 AZ / ...3 r /V ,.. aj©6 ��Ax`-'t --.___,.. c.b.r / Iv' / r 0 , R ,c id a ` w'JI -, g�7' z mtc ie b£-Frzl o -76( 33 of 34,0 Vy P-�' "I have seen or observed, or believe I saw evidence of, ;- all objects such as houses, wells,trees, fences, etc., shown on this document. I also represent that I have u 'fitS''u t r ti I personally measured the distances set forth on the diagram." ()Afriii-d-Pi /2 "1 L—?‘ SIGNATURE DATE