1999-114 • e
Certificate of Compliance
• Town of Queensbury
Warren County,New York
April 13 99
Date,
0c 10 -D t .99114
This is to certify that work requested to be done as shown by Permit No. •
has been completed.
SEPTIC ALTERATION
This structure may'be used as a
20 LUZERNE RD.
Location
-Owner RICHICHI, PAMELA
TAX MAP NO. 130 . -3-7 By Order Town Board
T OF QUEENSBURY
(---
Director of Build-ing & Code Enforcement
•
.
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 99114
TAX MAP NO. 130 . —3-7 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to RICHICHI, _PAMELA
OWNER of property located at 20 LUZERNE 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
20 LUZERNE RD.
•
QUEENSBURY, NY. 12804
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
l I Wood Frame ( 1 Masonry ( )Steel ( 1
7. PLANS and Specifications
SEPC ALTERATION .AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 2001
PERMIT FEE PAID —THIS PERMIT EXPIRES Apr i 1 8 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 8 Day of Apr i 1 19 1999
SIGNED BY for the Town of Queensbury
•Building and Zoning Inspector
•
- application for SEPTIC DISPOSAL PERMIT
Town of Que,ensbury
AllDept, of Community Development Permit No. , J
Building&Codes Office A,
742 Bay Road Fee Paid $�11� �i‘,/Queensbury, NY 12804 '
, ,
Location of property for installation: /p9-'v L 0 L e/Liu *. C
Property Owner's Name: (7,4 Nl 2 ,4 P
t C j t c k r APR 0 8 1999
_ _ Property Owne 's Mailing Address; cP19 Al F SOWN OF OUEENSBURY
Installer's Name: J AN / TA-i2/ (Fale./A- Phone # 7 901 - 7 a S 7
Number of bedrooms (if residential): 3 Total daffy flow:
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
• Soil Nature: sand, loam, clay, other /depth:
•
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: not required, required [rate min, per inch]
Domestic water supply: municipal, well, other.
•
If domestic water supply is a WELL, water supply from any septic absorption is feet.
•
PROPOSED SYSTEM
(irci:t-' )
Septic tank )b b u gallon (minimum,size: 1,000 gal.)
Tile field: each trench S-O feet / Total system length: oZ 0 D ' feet
Seepage pit(s): number of /U% / size each: ft. by ft. .
Size of stone to be used: # 2. - / depth or thickness f feet
ri ..
•
HOLDING TANK SYSTEM:. (if required)
Number of tanks: ° Size of each: gallons
(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
or
approval granted which is based upon or is granted in reliance , any permitupon any material misrepresentation or failure to make a
material fact or circce]mown by or on behalf of an applicant;shall be void.
I have read the regulations with to this 'cation and to • by and all requirements of the Town of
Queenabury Sanitary Sewage Dispo • . ,....
Signature of responsible person: 0 Date: g- ! 9
TOW? OF QUEENSBURY ' 63O
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name IC
Location LUZnQ--
Date 21e/3 g Permit # 9 [JAI
SOIL TYPE: Sand-Loam-Clay-
Results of Perco at on Test-
(if ap licable) 'ate inute/Inch
TYPE OF YSTEM: 1
ABSORPTI FIEL;i : Tot.,l Len th
Length of e ch renc' ,e:1 cJ 5-0
Depth of tren � ._3
Size of stone Z_
SEEPAGE PITS: umber-
Size - t. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box - 2 i \-\-=\ ,
Dist. Box to Fi :ld/Pit tt
Openings Sealed.q4011111010 Partial
LOCATION/SEPARATIi
Foundation to Tank meet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan yff)No
LOCATION OF SYSTEM ON PROPE
(circle one)
Front - Rear - Left Side - Right Side
Middle Front -i-ddl-e
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Departed- c.
Bu ding Insp r
..... ----*
1r- .
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RECEIVED
OF UEEilooU /APR 0 8 1999
TObliNoF QUEEN
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ompliance
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c,l QUA;=t�S U ;`�uiLD1N9 D`PARTMENT
- .-f'Based on our limited examination,
compliance with our comments shall
APR 0 8 1999 not he construed as indicating the
O9'
lans and s ecifcations are in full
� R P�� �fi-C orri liQnc� � if;the cac+e.
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74
BUILDIP�C AND CODE
fa
TOWN n7--841.--tIl.:144, 4•Hzi-ityK.4,'''',.
REVIEWED BY � •
� .�L '� o 11 � . DATE qy Le i�`r`
� -jriffy LC" le'
A F Y( 5
' Of)
•
"I have seen or observed,or befieve 1 saw evidence of,
all objects such as houses,wells,trees,fences,etc.,
shown on this document. I also represent that I have
personally measured the distances set forth on the .a
7
a`7/ en„,/,/
,27_
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SIGNATURE DATE
,
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