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2000-570 x, TOWN OF QUEEN'SBUR.Y 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Com-munity Development - Building Ss Codes (518) 761-8256 CERTIFICATE OF C[IMPEIAN'CE --------------------- C/C Number: C20000570 C/C hate: Monday, August 07, 2000 Application Number: A200O0570 Permit Number: P20O00570 x, This is to certify that work requested to be done as shown by Permit Number P20000570 has been completed. This structure may be used as a Septic Alteration Residential Tax Map Number. 523400- 124-000-0002-010-000-0000 Location: 99 WEST MT, Rd Owner: MARGARET STUERZEBECHER y By Order of Town Board TOWN OwF QUEENSBURY G Director of Buikiirxg 8c C e EnVkcernent T OW14 OF QUEENSBiJRY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761 -8201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000570 Application Number. A20000570 Tax Nlap No- 523400- 124-000-0002-010-000-0000 Permission is hereby granted to: MARGARET STUER.ZEBECHER Owner of property located at: 99 WEST MT. Rd in the Town of Queensbury, to constructor place a Septic Alteration Residential 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. Owner Address: MAR.GARET STUERZEBECHER 99 WEST MT. Rd QUEENSBUR.Y, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency RAY KEW NY { Type of Construction: Septic Alteration Residential Value : $ Plans & Specifications SEPTIC ALTERATION AS PER APPLICATION $25,00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday, August 03, 2002 (Ifa longer period is required, an application for an extension mint be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of Queensbury; Thursday, August 03, 2000 SIGNEED BY for the Town of Queensbury. Dis 7nforcefnent Application for Permit — Septic Disposal System Town of Queensbuty 742 Bay Rood Queensbury, NY 12804 (518) 761-82,56 1 . OWNER. INFORMATION: _.......,_ ..........•,,,__............................. ..._..._...............,,,,,,..,............... t! atre Use Location of installation: Tax i4lap No. f / File Permit No - �J , f Fee Paid Owner's Name: I r Gj eo Address: 7 !� ....._.__. ..,_..................... 2. INSTALLER'S NAME : 4a' -tom:% PHONE NO. 3, RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply # of bedrooms with applicable ,gallons per bedroom to equal total daily flow) Year of Housg: No. of Bedrooms x CoMputation Total Daily Flow • - �" x 150 gaVbdnn �'- 980 - 1991 x 130 gallbdrm 1991 — present x 110 gallbdrm Garbage Grinder Installed yes 1 no t.� AUG 0 2 2000 Spa or Whirlpool installed yes _ ! no 1 o- i 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) Tooggraphy ure Around Water ._ Bedrock or Impervious Material Dom&s= Water Supply 1 '!nt /Is at what delfith crt what depth mr�rxtcf � g oam /V feet feet we Steep slope clay if well; water sripply 90 slope other from any septic-system depth: 1 ,Q absorption is fl. other PercolationnTT�o be completed by licensed professional engineer or architect) ,date: � minute per inch 5, PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 250 gallons to the sirs of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub, Septic Tank: 4 Q222 gallon (min, size 1, 000 gal.) Tile Field: each trench r Total System Length: Seepage Pit(s): number of size of each: fi, by fl, Size of Stone to be used: # / depth or thickness �_.feet Bed System Size: x Alternative System: length and/or size 66 HOLDING TANK SYSTEM: (if required) Number of tanks: I 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 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 ofan applicant, shall be void. I have read gulations weth ect to this application and agree to abide by these and all requeremen o the Town of Que b Sanitary Sewage Disposal Ordenance, Noe Sign atu of t-+esp slble p on © to TOWN OF QUEENSBURY BUILDING_ & COOE ENFORCEMENT 742 Day Road Queensbury NY 12804 { 761-8256 SEPT C DISPOSAL. Sy M INSPECTION Name Locati n +C. Date Permi t SOIL. TYP and_ Clay- Results of ercolation Test- ( if appiica le ) Rate-Minute/Inc TYPE OF SY ABSORPTION IELD: Total Length � Length of a ch trench Depth of tr nches Size of sto a SEEPAGE PI Number- Size -Stone s ft . :r ft . sized PIPING: Bldg. to Tank �, Size ype Tank to Dist . Nox it Dist . Box to Fi' I d/Pit r Openings Searedt, LOCATION/SEPARA ' r ° artia Foundation to Tank'. Foundation to Abso �Ption feet Separation of Pits feet Conforms as per P1 of 'PT air LOhCATION OF SYSTEM ON `PROPER a No { C ' one ) _ �^ont - r - eft S e Front - e e ri ght Side COMMENTS : + SYSTEM USE APPROVED; S" O Arrived: Depa r ding ar Are KyAL bcl` TOWN OF BUILDING REVIEWED 13 ( DATE S,�-f7i-fc,, flo-t tolAAI /Lf14� Rr I- S 7`�rr-RZb�c h � /f d r/,EST /'I T. 9 N,X ia?6o N