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98-745 rl CERTIFICATE 01j, COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Date December 3 19 98 This is to certify that work requested to be done as shown by Permit No . _ has been completed . SEPTIC ALTERATION This structure may be used as a Location 4 LUPINE LANE Owner VAN GARDEREN , GEORGE & _ TAX MAP NO . 119 . 2 - 3 . By Order of Town Board TOWN OF QUEMSBURY Director of Building & Code Enforcement BUILDING PERMIT VALUE $ to TOWN OF QUEENSBURY fla. _ q A 745 _ TAX MAP NO . 119 . - 2 - 13 . 1 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to_ VAN G�i?E RE1M 'p GEORGE & OWNER of property located at 4 LUPINE LANE Street, Road or Ave_ in the Town of Oueensbury. To Construct or place a CFPTTC AT 'r1rRA"rTCM 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. OtMNER'S Address Is JOAN 4 LUPINE LANE QUEENSBURYr NY 12804 2. CONTRACTOR or SUI LOeR 3 Name QUEENSBURY SEWER 3. CONTRACTOR or BUILDER'S Addrea JAY SWEET 0 4. ARCHtTECT'S Name S. ARCHITECT'S Address G. TYAE of Constructlon — 1piease indialta by xf SEPTIC t l Wood Frame l 1 Masonry t l Stool l l 7. PLANS and Specifications SEPW*TC ALTERATION AS PER PLOT PLAN SPECIFICATIONS a. Proposed Use SEPTIC ALTERATION 25 December 2 2000 S PERMIT FEE PAID -- THIS PERMIT EXPIRES , dig (if a longer period is required an epplieation !or an entension must be nmwft to the BuiidkV and Zonkrq inspector of the town of CkownsbarY before ow osWiration date,i 2 December 1998 Dated at the Town of Queen rY this flay of i9 SIGNED BY _ for the Town of Oueansbury $uktdkrq and coning knapeAW Application for SEPTIC DISPOSAL PERMIT Town of Queensbury Permit No. Dept. of Community Development Building & Codes Office Gam( 742 Bay Road Fee Paid $ Queensbury. NY 12804 Location of property for installation: - - - "� e-f ©I A ' Property Owner's Name: Property Owner's Mailing Address: t,4 Re wecl � Installer's Name: 1�'c e_ C, YJ Phone # Number of bedrooms (if residential) : Total daily flow: (residential - compute 150 gal.Tbdrm.) Topography: flat, rolling, steep slope 5'0 of slope Soil Nature: sand, loam, clay, other I depth: Ground water. at what depth? feet 1 Bedrock or Impervious Material: at what depth? � feet Percolation test: - not required, required [ rate min. per inch ] Domestic water supply: ., municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. PROPOSED SYSTEM Septic tank: gallon (minimum size: 1 ,000 gal.) Tile field: each trench -% feet 1 Total system length: fa e) feet Seepage pit(s) : number of / size each: ft. by ft. Size of stone ro be used: # depth or thickness e� / r 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 Queensbuxy, 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 of an applicant, shall be void_ I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance- Signature of responsible person: - 4 'G � Date: fy t TOW OF QUEENSBURY BUILDING E CODE ENFORCEMENT 742 Bay Road Queensbury MY 12804 (518) 761-9256 SEPTIC DISPOSAL SYSTEM INSPECTION! Name Location t E .,ry• .�Q t�,ryti C } Date Permit #. 1 f1� SOIL TYPE San Loam- Clay- Results of Percolation Test- ( if applicable ) Rate-Minute/ Inch TYPE OF S STEJMl: ABSORPTI2RAT Total Len h Length ofen ,h r Depth of Size of st SEEPAGE PIm r- Size - x ft , Stone stize PIPING : Si�xe ype Bldg . to Tan Tank to Di N � Dist . Box / 6rk Openings Sled ? Ye No aP rti a1 LOCATION/S Foundation to Tank J " feet Foundation to Absorption feet Separation of Pits eet Conforms as per Plot Plan �--Wesj No LOCATION SYSTEM ON PROPER ( circl ne Front Rear Left Side - Right Side Middle - Middle Rear COMIMERTS SYSTEM USE APPROVED: OES NO Arrived. � '' Deprted: i ui ding nspector u v TOWN OF QUEENS URY BUILDING & RT. REVIEWED BY DATE I �III�K�iM�11►1[1�I #MCI � Emma F k 1 I