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97-302 • CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date June '3 19 97 -,3oq , 0 _ 5- �-� 97302 This is to certify that work requested to be done as shown by Permit No. has been completed. This structure may be used as a SE:"TIC ALTERATION Location 84 I IPA I N S-�'T. Owner F 1 UBACHE R, 9;TE PF1T�N & PAMELA _ By Order of Town Board TAX HAP NO. 134 . -`' -1 TOWN OF UEENSBURY Daf," • Director of Building & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY VALUE $ 0 No. 97302 TAX MAP NO. 134 . —5-1 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to FT,T)RAr liTIR S-T-F'-P-F'N OWNER of property located at 84 MAIN ST 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 PAMELA 503 PINYON DR. SCHENECTADY, NY 12303 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. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) SEPTIC ( I Wood Frame ( I Masonry ( )Steel 7. PLANS and Specifications SEP°PIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8. Proposed Use SEPTIC ALTERATION $ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES June 9 19 99 (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 9 Day . June 19 97 .40 SIGNED BY . dirr' for the Town of Queensbury Building and Zoni '• nspector ,:Application for SEPTIC DISPOSAL PERMIT Town of Queensbury Permit No.R 1-30a Dept. of Community Development Building&Codes Office 0 0 742 Bay Road Fee Paid $ Queensbury, NY 12804 Location of property for installation: /� NA/ " (rr Property Owner's Name: &l4-‘ (J /4 i< -e,�• Y Property Own 's Mailing Address: -5-63 pZ N y 0,' 2 Jc &. e,� e c ii t / /a 9) Installer's Name: �N !7�`'1 dek/JV Phone # 9 d- - Number of bedrooms (if residential): P` Total daily ow: '3 o (residential)-compute @ 150 gal./bdrm.) Topography: vL flat, rolling, steep slope % of slope • /3 L • Soil Nature: 01-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: t municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. • PROPOSED SYSTEM x,ve FX. ii� ' v ' Septic tank )___ gallon (minimum size: 1,000 gal.) JUN 6 1997 Tile field: each trench feet- / Total system length: t--" , . I `,"=tNS3URIe _ 1 � • '.. :t ,��V© Seepage pit(s): number of / / size each: / ft. by f. • CODE Size of stone to be used:. # / depth or thickness feet 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 Queensbury, any pence 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 of an applicant;shall be void. I have read the regulations with • this '•:,..'cation and abide by these and all requireiments of the Town of Queensbury Sanitary Sewage ••.•`\cal f /, y4 Signature of responsible person: Date: .- ___ WHInil TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT �Lk 742 Bay Road Queensbury NY 1280 , (518) 761-8256 W"i ‘\(\:•• : SEPTIC DISPOSAL SYSTEM INSPECTION Name ' 00 GLc'i 0001\ Location Wvl r\k,kiv-N, Jam` DateLP ___ 17 Permit # f 73() ) SOIL : Sand-( am-Clay- Results of Percolat'on est (if applicable) Rate M nut- Inch TYPE OF SYSTEM: ABSORPTION FIELD• To ;1 Length Length of each trenc Depth of trenche Size of stone SEEPAGE PITS: Number- Size - ft. x irk) ft. Stone size a, PIPING: Size Type Bldg. to Tank —E341?TiA Tank to Dix C'_ _h17 D -to Field/Pit_ Openings Sealed? ste, No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption 70.feet Separation of Pits feet Conforms as per Plot Plan 1W1 No LOCATION OF SYSTEM ON PROPER : (circle one) _ ont - Rear eft S ' - Right Side Middle Front - Mid Te Rear COMMENTS: • SYSTEM USE APPROVED: Y NO Arrived: �. — r! Depart:.4 A� ,- Al dL. :u Iding In r •r ,111 have sten or observed,or Wove I taw evidence oft all objects Such es houses,wells,trees,feta%den shown on this document 1 also represent that I have (Po119V measured the distances set forth on the diagram." (,,e4 / ? SIGNATUR9 \DATE -i RECEIVED JUN .0 6 1997 pcm- • (,ItiEE•i&OURY bkttAC4-tial Bui,..DiNG AND CODE V . N 0 1 \**-j TOWN OF (2,0,JE:PNVI U .5,4 eAS BUILDING 8, REVIEWED BY ff DATE °di C dY- Artr--7/ pito