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1999-197 CERTIFIC1TE -•O ! COMPLIANCL ' - . , - . • ,-TOWN Of QUEENSBURY WARREN COUNTY. NEW' YORK . Date- - . May 6 19 99. 99197 ' This :IS •to .certify that -_work requested to",be. done as shown by Permit No. •• - ' - has ,been completed. . . SEBT.IC AL' 'ER'ATION , . . This structure may be 'used as a' , 21 KILEY LANE ..Location ' . GENTHNER, ALICE = . • Owner - -. - • TAX MAP .NO.. . 80.'-1-25. 54 - : . - By Order. .of Town 'Board ,..„ , TOWN. .OF U NSBURY ,. , . - , Uirector'of Building &, Code ,,Enforcement ' BUILDING PERMIT VALUE $ 0 TOWN OF QUEENSBURY No. 99197 TAX MAP 'NO. 80..-1-25 . 5+4ARREN COUNTY, NEW YORK PERMISSION is hereby granted to GENTHNER', ALICE OWNER of property located at 21 KILEY LANE Street,Road or Ave. in the Town of Queensbury,To Constructor place a SEPTIC ALTERATTr)N 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 21 KILEY LANE QUEENSBURY, NY. 12804 2. CONTRACTOR or BUILDERS Name SANITARY SEWER " 3. CONTRACTOR or BUILDERS Address DAN DRELLOS PO BOX 224 GLENS .FALLS- NY 1.2801 4. 'ARCHITECTS Name 5. ARCHITECTS Address • 6. TYPE of Construction—(Please indicate by X) SEPTIC ( )Wood Frame ( )Masonry ( )Steel ( ) - 7. PLANS and Specifications ' SEPC .ALTERATION AS PER. PLOT PLAN SPECIFICATIONS 8. Proposed Use - SEPTIC ALTERATION 25 - April 30 19 2001 $ PERMIT FEE PAID —THIS PERMIT EXPIRES. (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 dated 30 Dated at the Town of Queensbury this Day of Apr i 1 1999 19 SIGNED BY for the Town of Queensbury Building and Zoning Inspector Application for SEPTIC DISPOSAL PERMIT f Town of Queensbury I_ r Q �] • Dept of Community Development Permit No. I ( 1 / Building&Codes Office CO 742 Bay Road t „ Q"IPpri_sbury, NY 12804 9 919 7 8 0. —1—2 5 5 4 ' GENTHNER, ALICE i.._._ 21 KILEY LANE ON;: '_.:.�. Location of property for installation: -'� .:._.._ � ,.. - SBPTICALTBdATI _ Property Owner's Name: (Q (© /v r4,tJ,rfL- / APR 3 0 1999 Property Own 's Mailing Address: 2-/ 1<" L c (�-.�� TOUbSJ GP QUEENSBURY BUl WG-A�JD CODE Installer's Name: A-N l Tim ��.�- Phone # Number of bedrooms (if residential): 2 Total daily flow: 3 C (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: Q not required, required [rate min. per inch j • Domestic water supply: municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. • PROPOSED SYSTEM Ex/tr toll 6 Septic tank )Ole gallon (minimum.size: 1,000 gal.) Tile field: each trench ,1�//�' feet / Total system length: ' feet Seepage pit(s): number of / / size each: ,k) ft. by 6 ft. • Size of stone to be used: # 3 / depth or thickness Z/ feet • HOLDING TANK SYSTEM:. (if required) Number of tanks: Size of each: gallons CAlarm syeteaa afld associated electrical wont to be inspected by a c eatified agency. ' Y'"`"_ For:yauc.ptotectiaa, please rote that pursuant to Section 136-29 of the Code of the Town of Queenabbary, any permit or appioval'granted which is basedupon or is granted in reliance upon any material misrepresentation or failure to make a material fact or circumetanca]mown by or on behalf of an applicant;shall be void. I have read the regulations with sea pplicatioa and to abide by thetas and all requirements the Town of Queenebury Sanitary Sewage Dispo O .0)a Signature of responsible person: Date: if at 9 9 p e at A TOWN OF QUEENSBURY 44111ir; ' BUILDING & CODE ENFORCEMEN 742. Bay Road Queensbury NY 1280y/� /6.7b (518) 761-8256 V, SEPTIC DISPOSAL SYSTEM INSPECTION Name Location Date :5— ,39 l Permit # SOIL TYP an oam- - Results of Percolation Test- (if applicable) R. -- inute/Inch TYPE OF SYSTEM: ABSORPTION FI , D: Tota Length Length of eac trench Depth of trenches Size of stone SEEPAGE PITS: mbe - 1 Size - t. lc.) ft. Stone size PIPING: Size Type Bldg. to T. CNr_t-srt a3L Tank to Dist B-ox r� tt PAC' Dist. Bcx to Fie I Pi k " Openings Sealed? elitaallW No Partial LOCATION/SEPARAT Foundation to Tank 6mi-(. feet Foundation to Absorption Zip feet Separation of Pits _ t Conforms as per Plot Plan e o LOCATION OF SYSTEM ON PROPER . (circle one) Front - Re. - eft Side - Right Side Mi. - •l "-ddle Rear SYSTEM USE APPROVED: 41011W0 Arrived: Depar uiiding In for s "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells,trees,fences, etc., on this document I also represent that I have 1 person Ily measur e distan es set forth on the iagr SIG A URE .............. 3z2 ?".1 D TE Q — / 92 hECEVED 6 p,4-11-+ APR 3 0 1999 T WN OF QUEENSBURY BUILDING AND CODE , —'�o t o G ,� ��� i O J n ✓ ►6O,x�, TOWN OF Q E $ : BUILiN - - REVIEWEDY DATE ._. ! -,,.... l