98-709 CERTIFICATE Ol! COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date November 10 19 98
98709
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 BIRCH RD. --
Owner FRANK, AUSTIN & MARGARET
TAX MAP NO. 39 . -1-65 By Order of Town Board
TOWN QF QU URY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 98709
TAX MAP NO. 39. -1-65 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to FRANK, AUSTIN & MARGARET
OWNER of property located at 4 BIRCH RD. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SRPTTC AT.TFRATTfN
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
4 BIRCH RD.
LAKE GEORGE, NY 12845
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( I Steel I )
7. PLANS and Specifications
SEPTI&ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES November 10 192@@@
(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 1@ Day of� November 19 1998
SIGNED BY �`��()4 '�1 for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No.
Dept. of Community Development
Building&Codes Office
742 Bay Road Fee Paid $452:-
Queensbury, NY 12804
' L J
Location of property for installation: Y//Lct /1J tiv L ee GA S
Property Owner's Name: 8 RA-d + �, Fla 0,
‘:/Property Owner's Mailing Address: /cc L AD 1��,L- w
Installer's Name: v)oleo r rs .ram:,,` fe:z v,c• Phone # `79L-7 Z 57
'1
Number of bedrooms (if residential): 3 Total dailyflow: ke)
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: ie 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: municipal, ) well, other
If domestic water supply is a WELL, water supply from any septic absorption is /SQ feet.
PROPOSED SYSTEM
Septic tank 100 gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: ' feet
Seepage pit(s): number of Z / size each: 6P ft. by ? ft.
Size of stone to be used: # 3 / depth or thickness `Z 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 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 -..- to this !.... •• and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage .• .. •�.
Signature of responsible person: r OG-144.1/(.K— Date: l/ l9 9 p
r
1/ 2
TOWN OF QUEENSBURY lLO- \VM
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name .�� l
Location-'
41 Date\\_ \O -"‘ Permit # — V
SOIL TY an -Clay-
Resul is of Percolation /-st-
(if applicable) Rate- , nute/Inchlik
TYPE OF SYSTEM:
ABSORPTION FIELD: T/ al Length 11116,
Length of each tre h
Depth of trenches
Size of stone
SEEPAGE PITS: N ier-
Size - ft j x 16 ft.
Stone size _ ;; k
PIPING: Size Type
Bldg. to Tank _tA2,71 1
Tank to Dist. Box -1I' Ma&ifn744:--4-14-0
Dist. Box to Fi el d 'i t " A (:?,;.
Openings Sealed? 1Mo' No Partials
LOCATION/SEPARATION'
Foundation to Tank y . cT feet
Foundation to Absorpt' . . . - L:feet 1
Separation ofPits ?y} feet 1
Conforms as per Plot P1 a Yes No
LOCATION OF SYSTEM ON PROP • k •
(circle one)
c: RParC' l ft Sid Right Side
Middle Front - Middle Rear
COMMENTS:
L\ 5 Pc iss +
SYSTEM USE APPROVED: YES NO
Arrived: a
Depa • . .,:
/:uilding , pector
TOWN OF QUEENSBURY ii.36
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ()6.
Location _ /iz lel
Date //3 r Permit #
SOIL TYPE: Sand-Loam-Clay- 0
Results of Percolation Test- !
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trenc
Depth of trenches
Size o stone
SEEPAG PITS: Nu '.er
Size - f . x ft.
Stone siz-
PIPING: Size Type
Bldg. to Ta►
Tank to D' t. Box
Dist. Bo to Field/Pit
Openin. Sealed? Yes No Partial
LOCAT a /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:
SYSTEM USE APPROVED: YES NO
Arrived: pi
Departed:
Building Inspector
I
"I have seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences,etc.,
s n on this docu 1 also represent that I have
peso ally measur a ista;� ,7forth once diagram."
\., , 04.4.g— I / Ci qp----
SIGN T E DA
f
r t> -tit_ .-L !.*«.
•
d T\
L,
I v c
') 0 c% 0 ?c,, 4( ,
Z.
)4I .,,t, _ \
X
V '''',,,,,,,,,„
4:4 A,°O i,' c-------------7
z
1 ix.-`,
. /7'.'2:f E
11 leii
(3
E