2001-762 Alift TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010762 Date Issued: Thursday, October 18, 2001
This is to certify that work requested to be done as shown by Permit Number P20010762
has been completed.
Tax Map Number: 523400-308-018-0001-043-000-0000
Location: 17 REVERE Rd
Owner: JOHN &KATHY ANNE OBST
Applicant: JOHN &KATHY ANNE OBST
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
4 '#1.- -*-
(.' aivxp ' , N..
Director of Building&Code Enforcement
,
, TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010762 Application Number: .A20010762
Tax Map No: 523400-308-018-0001-043-000-0000
Permission is hereby granted to: JOHN& KATHY ANNE OBST
For property located at: 17 REVERE Rd
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: JOHN&KATHY ANNE OBST Septic Alteration Residential
17 REVERE Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name./ Address Electrical Inspection Agency
Plans &Specifications
2001-762
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, October 12,2002
(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 arhe47n oQueensb ; Friday, October 12,2001
SIGNED BY / fs . �; *" for the Town of Queensbury.
Director o ,&Code Enforcement
0-3
Application for SEPTIC DISPOSAL PERMIT
/
STAMP RECEIVED Z
Location of property for installation: /7 "�`y��� O
Owner's Name O/&S I PERMIT NUMBER 10
Owner's Mailing Address: _/7 jeJ Ie ,AQd-ovi- 1-76,„ t'll
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t FEE PAID i
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�� t992_l��Installer's Name: ( V` / ���� Phone #: CA
Number of bedrooms (if residential): OCT N
20��
Total daily flow (residential -compute @ 150 gal. per bedroom): TOWN
OF
QUEENSBURY
Topography: Plat I-1 Rolling f7 Steep Slope _BUILDIC,
ODE
Soil Nature: Sand n Loam n Clay IT Other /Depth:
Ground Water: at what depth? feet
Bedrock or Impervious Material: at what depth? feet
Percolation Test: Not Required I I Required/Rate min. per inch
Domestic Water Supply: '6" Municipal 1-1 Other
If domestic water supply is a WELL: water supply from any septic absorption is feet
IPROPOSED SYSTEM:
Septic tank: gal. (minimum size: 1,000 gal.)
rr- t
�Tile Field: each trench 6 O`a6 feet. / total system length feet.
Seepage Pit(s): number of / size each: ft. x ft.
Size of stone to be used: # / depth or thickness feet.
`y�d�iG%-A4--e I
HOLDING TANK SYSTEM: (if required)
•
Number of tanks: • Size of each: gal.
•
111 Alarm 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 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.
Simnature o f responsible person: ._ �� / t
�/I Date:
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TOWN,tcOF QUEENSBURY .33D_
BUILDING & CODE ENFORCEMENT
742 Bay Road 'qt1('
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ceSk. er •
1 WN e
Location \ ww, q
i� ,
♦ r-7
Date , 6 - 1 " ll` Permit '( �! .A
SOIL TYPE San. Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: ---T-
ABSORPTION FIELD: Totalqlgtp 6`I
Length of each trench
Depth of trenches .
Size of stone C ,s6-A./ ; ,5'S ,
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size .�
PIPING: Size Type
Bldg. to Tank _ �-sC/STI42
Tank to Dist. Box li"
Dist. Box to Field/' . A 4 '
Openings Sealed? Ye No :Partial
LOCATION/SEPARATIONS:
Foundation to Tank / feet
Foundation to Absorption . " feet .
Separation of Pits • •
eet
I )
'Conforms as per Plot Plan Ye No—7
LOCATION OF SYSTEM ON PROP' RT :
- ,e one)
Fron - Rear - Left Side - Right Side
'i dle Front. - Middle Rear
COMMENTS:
56'- - A ---;- .6 0(t---7— igli-'1)
•
SYSTEM.USE APPROVED: YES NO
Arrived:
Departed: ♦ ra[/ . •
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Building Inspector
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r�' all objects.such as houses, wells, trees, fences, etc., o ,
�i shown on this document. I also represent that I have ®n
�a2 personally measured the 'is' ces set forth on the diagram." •
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'IGINATURE DATE
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