1999-564 •
• Certificate of Compliance
Town of Queensbury
Warren County,New York
Sertember 15 99
Date -
•
• 99564
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC SYSTEM, 2 BEDROOMS
This structure may be used as a •
75 PALMER DR.
Location
Owner GATES, LAURIE A.
TAX MAP NO. 14 -33
By Order Town Board
QUyyNS •
Director of Building& Code Enforcement
WANNINZIMPOMMOMMASESIII*. Xar
•
BUILDING . PERMIT
VALUE $ 0 TOWN • OF- . QUEENSBURY No 99564
TAX •MAP NO. 144 . -1-29
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
GATES, LAURIE A.
75 PALMER DR. • Street,Road or Ave.
OWNER of property located at
To Construct or laoe a • SEPTIC SYSTEM, 2 BEDROOMS
in the Town of Oueensbury, p
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.
t.`OI1E VineElprffilis DR.
QUEENSBURY, NY . 12804
2. CONTRACTOR or BUILDERS Name •
SANITARY .SEWER
•
3. DORM PilinEfiRM L DEPcY.etti3As 2 2 4 .
GLENS: FALLS. NY. .:...1.2801
4. ARCHITECT'S Name-
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by)c) ,..SEPTIC.,?;
( ►Wood Frame ( I Masonry ( )Steel ( 1
7. PLANS and Specifications •
SEPTIC' -SYSTEM. FOR 2 BEDROOM RESIDENTIAL. AS PER. PLOT PLAN AND
SPECWFICATIONS
8. Proposed Use •
SEPTIC. SYSTEM, •2.' BEDROOMS •
• • • .-.• August 31 2001 .:
$ PERMIT FEE PAID —THIS PERMIT EXPIRES . 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 QueensburY before the expiration date.)
31.:.. : August:. 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY _ for the Town of Oueensbury
• uilding and ZMiing Inspector
Application for SEPTIC DISPOSAL PERMIT
99564 144 . -1-29 .
•
Town of Queensbury.,j GATES, LAUR IE' A. '
qq-
Dept- ermit No .t. of Co mmunity. `••'7 5 PALMER=PALMER DR.
Bnrkrii. &Codes'UM- ' SEPTIC.SYSTEM, 2 BEDROOMS
742 Bay Road Fee Paid
QueensbUIJ, NY 12804
Location of property for installation: 7 l/-t C z2 r+r's
Property Owner's Name: Loti 2/ g A P r AUG 3 1 1999
Property Own 's Mailing Address: ( -vtil C �OTOWNQ`� �=BURYcuLD:No AND CODE
(A_
Installer's Name: 4-ac) Phone # 7 92 -7 Z�
Number of bedrooms if residential): c3
---- - - ----� ) -z - - Total -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, /V, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. .. •
•
• PROPOSED SYSTEM( rz.d T/N (o)
.Septic tank I°a° gallon'(minimr,m.size: 1,000 gal.) (Z,-) FiCrt2,-rot
Tile field:-each trench 33 feet / Total system length: 13 2-- • feet
Seepage pit(s): number of GV/4' / size each: ft. by ft. •
•
• Size of stone to be used: #, 64s/4- / depth or tfrk4r,x5 . feet
•
HOLDING TANK SYSTEM:. (if required)
Number of tanks: Size of each: gallons
(4alazm syato n and associated electrical vsor;c to be inspected by a certified agency.
^�' _ note that�, ;;��,�fFor+ y�otectic�n, pleasepurauaat.to Section 136-29 of the Cods of the Town of Qaeeasbmy, airy peanut or
,'',:0°a;,aj, granted which is based tpon or is granted:in reliance upon any mate ial misrepresentation or failure to male a
' Material"''fact or circumstance lmown by or on behalf of an applicant;licant•shall be void.
''. •
;I •have rend the regulations with application and •. :_ abide these and all requirements of the Town of
Queenabury Sanitary Sewage Disposal ',!"‘
Signature of responsible person: l' ' Date: d /? b/9
-•,)i ._,_. A ,
_... • qq,5e(0)_/ .
) .
—., ) • _
<_ ,,z ID ❑ a
o ikiN v
s w
N
m
. 4 !
C.
N Ft
° N F ( t,:..:Ni A U RY
BUILDING L C.. `�6 6.�`s �n ��o
REVIEWED BY .C , -
DATE • 7b tI
AUG '' )
ro 31 1999
-7V OF
BUILD QUE.'
Pi c'
� C7 0 i
oP--1HM
seen or observed, or believe I saw evidence of,
"I have etc.,
all objects such as houses, wells, trees, fences,t hat I have
• s t ,n ,- .. document. I also rep
•. h• di ces set forth on th diagr m."
pe�rson. ly .tired tPlYl
i IG-ATURE