95-462 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: 95462 Date Issued: Friday, August 11, 1995
This is to certify that work requested to be done as shown by Permit Number 95462
has been completed.
Tax Map Number: 523400-302-014-0002-072-000-0000
Location: 6-8 LINDEN Ave
Owner: WILLIAM BERNARD
Applicant: WILLIAM H BERNARD
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
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Application for [SEPTIC DISPOSAL PEI?MI
SIAMP
Location of Irroperl,y for installation: ---�==- J^'��� &-e
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Owner's Narnr: ,' ------
1 lilt�ll'I'NU11111 It
Owner's Niniling Address. u
OwlInSIJIICf'S Nonto:
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Number of bedrooms (if residential):
Total daily flow (residential - compute (ii: 150 gal. her bedroom): __ _
Topography: [V]Flat [_] Rolling Stevp Slope 11, of Shope
Soil Nature: Sand [�] Loam [� Clay ] Other /Depth:
Ground Water: ::t %%h::t depth? _ feet
Bedrock or Impervious Material: at what delrlh? feel
RECEDED
I'ercolatiun I'csl: � � Not Rcgnircd Rryui:cel/Balt _RECEIVED
incl:
Domestic wafer Snl,ply: tK Municipal Well o t►II1, G 111995
R
supply TOWN OF OUEE B RYIf domestic wafer supplyrs a WI1.1,: water from an septic absorITionis87tt ANDE
11It( POSIiU SYS II?M: I
Septic lank: g::l, (:ui::iinum size: 1.000 gal.)
'file Field: each Trench feet. / luta) system Ienglh feel.
Seepage I'il(s): number of / size each: :� ft. s It. plr4�
Size of stone to he used: 1< ! depth or thickness I _ feel, lf��l��f �JP�
HOLDING TANK SYS7 UM: (if required)
Number of•tanks: _ Size of each: gal.
illurm .cys(em cru/ u.ccormJerl rleclrie(rl work to be inspected by it cxrYificd agency.
/•i�r
),off)-protection, please note Aral pnnctuarrt to Section 1.36-29 of the Code o f the 7'ottvr v f
Queenshury, filly hermit or n p prorarrl grained which is based upon or is granted in reliance ►r pot
nny nraterifil Inisr•eIll esenmtion fir fiuibue to nralce a material fact or circrrnrswitce known br or on
behalf of an a p plic•rrnl, shall be void.
I have read the regulolions frith respect to this a plic•rtll.M alyd agree Irl chide by these and all
requirernerrls o f the Town o f'Queensbn •y,S(t i r)• ,Sena a )is rosal Ord fiance.
.Signature o f respoitsib'e person: Date: �6 .J
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12604
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
i � s
Location L le- 4,1 r—
Date /' Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total 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:
/ori ✓�s�'�?✓ � .Sa-��r7�
v� crr�4�r nef4,-e of-
SYSTEM
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: s�
Building Inspector
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BUILD,ITtAr
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RECEIVED
A U G 111995
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TOWN 011�QUEE:NSBURY H.THORAS JRRRTI,PF-
12 AND GUpE 12 East Washington St.
Glens Falls, NY 12601
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