91-284 \
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date In riff- /f) 19 5
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This is to certify that work requested to be done as shown by Permit No. 91-284
has been completed.
Septic Alteration
This structure may be occupied as a
Location 29 ft:eel:tarot 11111 901
Owner Kathy Hughes
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY ' x
No. 91-284
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Kathy Hughes LID
OWNER of property located at 29 Cottage Hill Rd Street, Road or Ave. 4'
in the Town of Queensbury,To Construct or place a Septic Alteration
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at the above location in accordance to application together with plot plans and other information hereto filed and E
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name e+
Ivan Bell CD
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name r+a.
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic Alteration to include: 2 seepage pits; each 8' x 8' using
f3 Stone, 2' Thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 8, 19 93
(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 �-th Day of • 19 qt
SIGNED BY 6c / for the Town of Queensbury
Building and Zoning In : ctor
/ w, TOWN OF QUEENSBURY
Area a APPLICATION FOR SEPTIC DISPOSAL PE'jkl -/
GATE: nEcriiveo
LOCATION OF PROPERTY FOR INSTALLATION ? 9 e o/ 4 i, A/,// MI MAY 81991
Owner' s Name:
Address: 9 ('oh'&lz, /1d1 Pt-rhi✓try fi
Installer' s Name: lie, ,�. j,�t11 Telephone: ng,69‘,/
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) 4/ j---0
Topography: Circle one: is, Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? -r v Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: (not required) required
Rate - Min. Per Inch
Domestic water supply: Circle one: CMunicipal Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank C xisfi!ai r gaf. (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each RA, 2 feet
by feet
Size of stone to be used #. 3 /Depth or Thickness feet
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HOLDING TANK SYSTEl3IF<Igo) 6n, 'r ; )Es
NO. of Tanks REii15iteL=o YE
*Alarm system and associated electrical w'6OkTEta_..be— n—approved
agency.
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: ��..—pi ny- DATE: (.57 7/
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.awn o/ Queen`34ur,
BUILDING and ZONING DEPARTMENT
Bay and,Fitviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME - C o. ) Ktif✓
LOCATION ( ci a_p, (', .,7 h A /1 m
DATE , / 9 PERMIT N0. 9 i— i
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SOIL TYPE - San - Loam t Clay -
Percolation Tes Requird? YES - NO
Percolation rate - Min/Inch -
TYPE of SYSTEM:
Absorption field, tot 1 length
Length of each trenc
Depth of trenches
Size of gravel
SEEPAGE PITS{Number ''of)
Size- Tft. X ; ft.
Gravel size
PIPING: ' Size Type
Bldg. to tank
Tank to dist. box
Dist. box to fie d/fit
Openings sealed? YES NO Partial
LOCATION/SEPARA IONS:.
Foundation to t nk I ft.
b Foundation to sorption ft.
Absorption to of line )oft.
Separation of its \ a-Oft.
LOCATION OF SYST ON PROPERTY(circle one)
Front Rehr Left sidle - Right side -
COMMENTS:
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SYSTEM USE APPROVED NO
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B ding I pector
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= 4, . a 9 K >.
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Vyo q TOWN OF Q3 EENSBUR\
REC=iVED
MAY
1991
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