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2002-220 E TOWN OF OUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761.8256 CEA"I"IFICATE OF ,COMPLIANCE Permit Number: P20020220 Date Issued: Tuesday,ApiH 09,2002 This is to certify that work requested to be done as shown by Permit Number P20020220 has been"completed. Tax Map Number: 523400.301-006-0002-056.000-0000 Location: 16 WESTLAND Ave Owner: KEVIN GODFREY Applicant: KEVIN GODFREY This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Direetor of Building&Code Enforcement r TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 { Community'Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020220 Application Number: A20020220 Tax Map No: ;, 523400-301-006-0002-056-000-0000 Permission is hereby.granted to: KEVIN GODFREY' For property_located at: 16 WESTLAND Ave 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. Type of Construction Value Owner Address:, KEVIN GODFREY Septic Alteration Residential 16 WESTLAND Ave Total Value QUEENSBURY,NY 12804 Contractor or,Builder's Name/ Address Electrical Inspection Agency SANITARY,SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans &Specifications 2002-220 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.06 PERMIT'FEE PAID-.THIS PERMIT EXPIRES: Friday,April 04,.2003 (If a 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 T Quee bu r day,April 04,2002 SIGNED BY for the Town of Queensbury. POW- Director of Building&Co e Enforcement 518 745 4437 FILE No.638 04z02 '02 AN 11:25 ID:TOWN OF QUEENSBURY FAX:518 745 4437 PAGE 1 Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: � ......._............ Offlee Use )) Location of installation: ! �� J 'OQJ File Permit No. Tax Map No. / / ff�3 A` /l Fee Paid owner'sQmer's Name: f C�U ............... ..........._... .. ........,.m _ Address: ' ''��'''"�''�� •� r� 2. INSTALLER'S NAME PHONE NO.�� --� 3. RESIDENCE INFORMATION: {circle ear of dwelling,indicate#bedroom(s) and multiply# of bedrooms with applicable gallons per bedroom to equal total da1lyflow) r� _,e�EIVED 1980 or older x 150 gal/bdrsn 1980—1991 x 130 gaubdrm = --APR U 2 2002 1991 —present x 1,y0 gal/bdrm _.. earbage Grinder Installed yes_ ! no TOWN OF QUEENSBURY Spa or Whirlpool Installed yes, / no BUILDING A 22 g2 q pARCEL INFORMATION: (circle applicable information &indicate mmsurements) or Impervious Mater&L_j2malio"�� at what depth at what depth i a well TSteep oam feet feet ifwell,,water supply ope cloy from any septte-system _ ope other absorption is depth: other Percolation Test: (To be completed by licensed professional engineer or architect) Rate:' minute per Inch �. PROPOSED SYSTEM: ��a=Call *uWM_ '°'11 indtvid g' 'aSo disposal systoms must be desigaecibY a lieanaed of fe sional engineer septic tan iaach architect field (Imless rr each Q bagc Grinder,p1w ps Boardor approved Tub. vision). Add 250 gallons to tln0 size j� C_dztsr,4 6 Septic'Tank' +'�� gallon(min. size 1,000 gal.) Pi jD Tice Field: each trench 1r Total System Length: `• 1I Seepage Pit(s): number of size of each: f by Size of Stone to be used: # depth or thickness .feet Bed System Size: x Alternative System: length and/or size 6. HOLDINCI TANK SYSTEM: (if required) Number oftank : / Size of each: gallons /TOTAL Capacity' gallons Note; Alarm System and associated electrical work must be inspected by a'Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) For•your protection,please notethet pursuant to Section 136 29 ofthe Code ofthe 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 act or . oireunv=mce known by or on behalf of an applicant, shall be void. I have re gulations with rsp ct to this application and agree to abide by these and all requir eirts► a Town of Quo sb Sanita Sewage Disposal Ordinanc . i ature of respo elble person �J aiwcvuz � 0 4-) ► C W 4- 0)H .� > w Q� a1 C ( � W ► C�'oN 4J (UC J ro vW u V) U. It (w_ �r� r �r r G1 Ca r G, 'o A» QI Hw i �x , u oI 4J -A 4J Z Inv L+'I c Q +d t ,, 0 f3 m v 0.,4 0 W r Z 4- ,0 " U.J . LL v! 004 0 z 4- 0 v C�, it 4 'r .J E C C Q .q U .0 n �r 0. IL,V) � © 00000 v U. (DIra r, v ,10 rWHUcv ► , x ► -� 0' 04" a.V a (A .0�` L6 ro v c 0 c 0 Id 14J 4-) 0 �r 0 © fu v i 0�►► '(0o -P v W w LL (ac HH ►► 4~ u ) P4JH 0) �- -r- U) 0r. ccta0 a) 0 w ' t� LW 0 ,r Vf 4- 0 CL N C x 0 0 0 w i V7 Lu 04 0 4. or0 0 0 IA V) H H 0 �,I 9� In aU- I 0 4-W Y) ►► 4.) 0 CO 0) -P 4J P -P A. I -C 0 Q I W 4 �C M +d M M � H r v Z�,j 4J � m a r I: 4J •C v � ► + r �""' "0ID � O1 U4JrW � �• w as ro v ..J LWOm4-) vC. vCmM.Yc +JCe. CC (d C10 IraIC r E U 4j H V) 4- 10C;A. NWN0L UCIAvU0 � CLCU '�- 0 '0 l it b 0 a) �r �+ MQ! 41'I-W 'r -Pbr- (tl 0.000a) 00US. .�0 �' L• 4J JCIV)V) V)U) IQQI-- CICJLLLLY) U -J LL2: U U'! ecQ f' 1 1 n�rl BUILDING r REVIEVI El) BY DATE 1 Maio uoo :)iVldl ll li 4 i <3 Of "I have seen or observed,-or believe I saw evidence of, all objects'such as houses,.wells,trees,fences, etc., shown on this docd ent 1 also represent that I have ersjn y measure t distances s orth on the ia&am." 0 -- {' 'SIGN A RE DATE . .� �. rod �LBP f