97-693 CERTIFICAT-m OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Novcmbcr 20 19 97,
This is to certify that work requested to be done as shown by Permit No. 97693
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location 1285 RIDGE RD.
Owner , BRESS, DONALD & MARGARET
By Order of Town Board
TAX MAP NO. 51 . -1-18 TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. ., 6 „
TAX MAP NO. 51. -1-18 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BRESS a DONALD & _ARGARET
OWNER of property located at 1285 RIDGE RD. 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
1285 RIDGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
CDAN` DRELLOS; PO BOX 224
. = a. 1a8fa 1
4. ARCHITECTS Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
( )Wood Frame 1 1 Masonry ( 1 Steel 1 I
7. PLANS and Specifications
SEPTap ALTERATION AS PER PLOT PLAN -SPECIPI.CATIONB
8. Proposed Use
E^•+� S 'l am-.ALTERAT RATION*
$ 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 Oueensbury before the expiration date.)
_ November
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
Building and Zoning nspector
Application for SEPTIC DISPOSAL PERMIT
r
Town of Queensbury _ CODept. of Community Development Permit No.
Building &Codes Office '�(' ()t)742 Bay Road Fee Paid $(J
Queensbury, NY 12804
Location of property for installation: I)v S. p l di, i
Property Owner's Name: Q pc ?) S r NOV 191997
Property Owne ' Mailing Address: Cr/ha
Installer's Name: ��t/ ' 77 L� Phone # 1 ? c
Number of bedrooms (if residential): Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: A"---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: }C 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 kc feet.
PROPOSED SYSTEM s V fr!1'f4i 1-N L t-
Septic tank: 1 Oat gallon (minimum size: 1,000 gal.)
Tile field: each trench 5° feet / Total system length: 02 0 0 feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # 2 / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CAlarm 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 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 re t to this pplication and abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal J Cj
Signature of responsible person: Date: / / // '97
g //<4
TOWN OF QUEENSBURY //bQ
BUILDING A CODE ENFORCEMENT
742 Bay Road 1.0'�
Queensbury NY 12804 21-k
�/�(518) 761-8256 dS
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (221=*et"EIV,CLO )2t y
Locat
?c4 <<� }
Date - Ct Perms t #
SOIL TYPE: Sand-Loam-Clay-9 7
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 - f x Alk ft.
Stone size
PIPING: ��- ype
Bldg. to Tank
Tank to Dist. Box '41111111_
Dist. Box to Field/Pi ,
Openings Sealed? Y s 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:
Ive" Gut— S c. y 44/6s
Vefgptce-
SYSTEM USE APPROVED: YES NO
Arrived: /aU
Departed:
Building Inspector
vJ U STVj� J: �`J.0 iv0 �1C..SL
TOWN 'OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road IF
Queensbury NY 12804 pytn
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location _
Date _ Permit # 011
SOIL TYPE: n l oam-Cl ay-
Results of Percolation Test-
(if applicable) Rat: ,inute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length 7 oc_l
Length of ch ench
Depth of tren — Z
Size of stone Z
SEEPAGE PITS: N 'ber-
Size - ft.
Stone siz:
PIPING: Size Type
Bldg. to Tank Eth-rib
Tank to Dist. Box i.} '5DE-7,15
Dist. Box to Field/Pit %%
Openings Sealed? 4,00411111110 o Partia
LOCATION/SEPARATII ' :
Foundation to Tank et
Foundation to Absorptionet
Separation of Pits _ feet
Conforms as per Plot Plan Ye
LOCATION OF SYSTEM ON PROPER :
(circle one)
Front - Rear - Left Side - Right Side
Front��Middle Rear
COMMENTS: -
SYSTEM USE APPROVED: NO
Arriv • '--
Dep
Building n ector
t
"I have seen or observed, or believe I saw evidence of,
al! objects such as houses, wells,trees,fences,etc.,
on is document I also represent that I have
pe son.I y me• ured ROSS set forth at the d
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IGNATURE
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