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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