97-190 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
• Date June 3 19 97
97190
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
8 VERMONT AVE .
Location
PROSSEP , LOIS E .
Owner
TAX MAP NO. 12S _ __4-11 By Order of Town Board
TOWN OF QUA.- . URY _
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97190
TAX MAP NO. 128. -4-11 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to PROSSER, LOIS E.
OWNER of property located at 297 VERMONT AVE. Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATTON
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
RD4 , BOX 297 , VERMONT AVE
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
SMITH_, FRED
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
SEPtP•C ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID =THIS'PERMIT EXPIRES May 2 ~• . 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 Queensbury before the expiration date.)
Dated at the Town of Queensbury this 2 Day of May 19 97
SIGNED BY
for the Town of Queensbury
Building and Zoning Inspector
TOM OF QUEENSBURY
BUILDING $ CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
NameR-o5Solv- 01,10,51
Location \ 1 Vj'vT'\ r'J'
Date 42_:I- 77.13Permit #9-7 —R p
SOIL TYPE: .Sand Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM!:
ABSORPTIO FIELD: Total Length
Length of 'each trench
Depth of trenches
Size of stone n2
SEEPAGE PH AN Number-
Size - ft y ft.
Stone size
PIPING: Size Type
Bldg. Tank
T o Dist. Box dp 4-/1-
Di st. Box to Field/Pi _ ' �� at,
Openings Sealed? e No Partial
LOCATION/SEPARATION .
Foundation to Tank /0 feet
Foundation to Absorption 0 feet
Separation of Pits - eet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPER
eVe one)
- Rear eft Si e - Right Side
Middle Front - 1 die Rear
COMMENTS:
'Si/oe. phi ffJA1
SYSTEM USE APPROVED: 000 NO
Arrived:
Departed:
Building Inspector
TORN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804 .
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name PAO j 6/P\
Location UG=0 } /62.
Date 5 5' y7 Permi t # -` — D
SOIL TYPE: Sand-Loa -Clay
Results of Percolate Test-
(ef applicable) Ra Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: , To al Length
Length of each trench "
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type •
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per P1 of P1 an Yes No.
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear .- Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
fn./4( /A) �, < 6- ,2j 6iuL
��Vv �
eoit2 p rJ 1 ,mil
SYSTEM USE APPROVED: YES (�•
s
Arrived: /L� s
Departed: 4.2
Building Inspector .
TOM? OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 4 N-C3 S Q/\C A /3
Location OCI 7 V CJYrI'o'i-
Date 5— j- '7 Pei`mi t # l-1— \c()
SOIL TYPE: Sand-Loam Clay-
Results of Percolat' n Test-
(if applicable) R t -Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: T al Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
/0 64:, c /_ /4.5, i d_ r-
SYSTEM USE APPROVED: YES 40'
Arrived: jr(W"
Departed:
Buirding Inspector
17
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— . Applicatlof for --.
STAMP RECEIVED.
' l SEPTIC-DISPOSAL PERMIT
. .
Location of properix fur illstallation:". ,1
.. .. I e- 6 ) I Z.JOI 740ss4D2 ' / 1'l!.lt-. i I' �illl�it .
Owner's Na ate: OWN`OFtEi::;+1S3URq /(1C
. Addresst li ti '1011-C ue _ BUILDING q►:r : AA
•
Installer's Name! Sm79f FEE PAID
Phone #: ( mil) 79Pg36
Number of bedrooms (if residential):
Total daily flow (residential -compute (ii 150 gal. per bedroom):
.Topography: ((lat (-) Rolling EI Steep Slope 4%1 of Slope
Soil Nature: Sand n Loam [—[ (lay [—i Other /Depth:
Ground Water: at what depth? • feet
Bedrock or Imper*us Material: at what depth? • feet
r
Percolation'1'est: Not Required I—i Required/Rate min. per inch
' Domei;lic Water Supply: • '• ' l \I Municipal (----1 Well [—I Other •
If domestic wtitcr supply is a,WI41. water supply from any septic absorption is feet .
.
PROPOSED SYSTEM:
Septic lank: �a v gal. (minimum size: 1.0(I0 gal.) '
'tile Field: each trench feel. / total system length feet.
Seepage I'it(s): number of i . / ' size each: ft. x _ ft.
• Site of stone to be'tised: #_ ' 3 / depth or thickness � feet.
IIUI..I)ING TANK SYS'11.1M: (if required) •
l • .
Number of tanks: I Size of each: gal.
�. ii .
ll: Alarm system ar,td associated electrical work to be inspected by d certified agency.
I
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of
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Queensberry, any permit off a pproral granted which is based upon or is granted in reliance rt port
any material ritisre preseu.tcf►ion or.failure to make a material fitct or circumstance known by or on
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behalf o fan a pplicaiit, shhll be void.
.
I
I have read the regulations with respect to this pplication and agree to abide by these and all
requirements o f the Town o f Queensbury S rt`' ry7IWwl Ordinance. '
177_,./ --- 9 7
Sjetrature o f responsible person: ___• /J Date:
r
Y A
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PLOT PLAN
SEPTIC SYSTEM
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Notice.: The following statement must be "stamped" on your plot
• plan. This sheet of paper may be used for purposes of
drawing your plot plan. After drawing such plot plan,
please 'read the statement and sign it. If you choose to
use other paper, for your plot plan, the office will stamp
those plans for your signature.
-
t X Ob
047
Ci NOlA r 0/XS 00
ISSN fl J l ei Ph
/ 1 goo/
C+ N 51
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L661, TO AV
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on th' document. I also represent that I have
personal ensure /the dis ances set forth on the diagram."
SIGN�IURE DATE
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