98-186 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Apr' 1 ?P 19 98
This is to certify that work requested to be done as shown by Permit No. 98188
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location 12 WESTLAND AVE.
Owner GIFFORD, JANE LAAKSO
TAX MAP NO. 8(� . - -25 . 33 By Order of Town Board
TOWN OF QUEENSBURY
LG�
Director of Building & Code Enforcement
BUILDING -PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No.
TAX MAP NO. 80.—1-25.3ARREN COUNTY, NEW YORK
PERMISSION is hereby granted to GIFFORD, JANE LAMS()
OWNER of property located at
12 WESTLAND AVE. Street.Road or Ave.
in the Town of Oueensbury.To Construct or place a SEPTIC ALTRPTj
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.
OWN1 2 WESTLAND. AVE.
QUEENSBURY, NY 12804.
2. CONTRACTOR or.BUILDERS Name
QUEENSBURY SEWER
3. CONJJAATgpCTTAf
�r++��11 ILDERS Address
0YY WW
4. ARCHITECTS Name .
6. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) SEPTIC. .
1 I Wood Frame ( 1 Masonry ( )Steel 1 1
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS.
8. Proposed Use
SEPTIC ALTERATION
25 Apr i1 27 2000.
S 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.)..
2.7 April 19
Dated at the Town of Gueensbury this Day of, 19
SIGNED BY _. for the Town of Queensbury
Building and oning a
Application for SEPTIC DISPOSAL PERMIT
•
Town of Queensbury 99— I W)<
Dept. of Community Development Permit No. 0
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
J
Location of property for installation: / ,1/ei f / n d A C -- \f� 10}
Property Owner's Name: Oa t,- --Nsg2,67— ( f1 r-- �. APR 27 1998
Property Owner's Mailing Address: SCQ Gist -_-- TOWN, ," D
Installer's Name: ( ��,c is"Vic.r y 7 feLJ-ter Phone # 7 f I D Z c/ I
Number of bedrooms (if residential): ,__ Total daily flow: LIS—a-
(residential - compute @ 150 gal./bdrm.)
Topography: )C flat, rolling, steep slope % of slope
Soil Nature: X sand, loam, clay, other / depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: y not required, required [rate min. per inch ]
Domestic water supply: X municipal, well, other -
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank:760 o gallon (minimum size: 1,000 gal.)
Tile field: each trench SZ% feet / Total system length: ,2 v d feet •
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: #-z 2- I depth or thickness 76 er feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CA1arm system and associated electrical work to be inspected by a certified agency.D
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 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: c cl � ' Date: 5
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1.., OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Cksy g-C+N/' 1)
Location 1_9, LAC41 arv.Q
Date 11/' 7W'Permi t # qg -" gip
SOIL TYPE (-i am-C ay-
Results o Percolation st-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION' FIELD: Total Le gth c4
Length of ach trench c_ ‘
Depth of trenches _
Size of stone ' _.Z
SEEPAGE PITSV Number-
Size - ft. x ft.
Stone size \
PIPING: Size Type
Bldg. to Tank \1(i--
Tank to Dist. Bgx / yO
- Dist. Box- to Fi eel d/Pi tT - u s-g=2SWc:
Openings Sealed?1 s--')_No Partial
LOCATION/SEPARATIONS-:
Foundation to Tank\/ j feet
Foundation to Absg�f'pti on -y-o-i- feet
Separation of Pits _ __feet
Conforms as per ,Plot\Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one) ,f
Front - Rear ,. Left Sid- - Right Side
Middle Front'- '...: a Re.r
COMMENTS: /
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2
SYSTEM USE APPROVED: CYESJO
Arrived: \U-. j
Departed)_-- _ -- r
t.,/,,8"ui ding Insp'e or