98-514 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date August 28 19 98
98514
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 17 DINEEN RD.
Owner EISENSCHMIDT, JOHN &
TAX MAP NO. 44 . -2-9 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 98514
TAX MAP NO. 44. —2-9 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to EISENSQJIMIDT r JOHN_ it
OWNER of property located at 17 DINEEN RD. Street,Road or Ave.
in the Town of Oueensbury,To Construct or place a SEPTIC AT.TF.RATTON
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 Oueensbury Building and Zoning Ordinance.
1. OWNER'S Address is
PATRICIA 444 DIXON RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
WESTOVER SEPTIC & LANDSCAPING
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
I Wood Frame I I Masonry ( )Steel ( )
7. PLANS and Specifications
SEPXdEC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 August 24 2000
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(H a longer period is required an application fawn extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
24 August 1998
Dated at the Town of Oueensbury this , Day of t9
SIGNED BY for the Town of Oueensbury
Building and Zoning Inspector
Application for SEP"1'1U DISPOSAL PERMIT
Town of Queensbury Permit No. 5/
Dept. of Community Development
Building & Codes Office
742 Bay Road Fee Paid $ G�
Queensbury, NY 12804
Location of property for installation: ,1-• ,>vcc/v. It/
Property Owner's Name: L)61/adf.,
7
Property Owner's Mailing Address: /7 / ;jt1 pew;,/ !S c
Installer's Name: SAcd d 4_O E'S/ ; ue,c Phone # ,S/b~2y>- 67/,
Number of bedrooms (if residential): \3 Total daily flow:
(residential - compute 150 gal./bdrm.)
Topography: Y flat, rolling, steep slope % of slope
Soil Nature: A sand, K loam, clay, other / depth: AU
o 1998
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
•
Percolation test: not required, required [ rate '.4'min. per inch J
Domestic water supply: municipal, I well, other
If domestic water supply is a WELL, water supply from any septic absorption is 100 feet.
PROPOSED SYSTEM
Eu.tbTt
Septic tank: \per gallon (minimum size: 1,000 gal.)
Tile field: each trench `40 feet / Total system length: 3 0 0 feet
Seepage pit(s): number of / size each: / ft. by ------ft.
Size of stone to be used: # / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: /l/,r' 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 respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal ' •' r�-
Signature of responsible person: /� Date: Z3 ^/ a —/ e
-4, i I.. 3 OL.LI 1°41
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name [1 I'S1ii'►-�Se.li
Location \-1 'i n E'm C
�Date — — 3 Permi t # cg---S1
SOIL TYP : San Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYST : 7
ABSORPTION FI LD: Tot. :ngth 3d
Length of eac tren
Depth of treni hes
Size of stone ,,
SEEPAGE PITS• ' umber-
Size - f x ft.
Stone - ze
PIP G: Si ,g y e
B dg. to Tank /tv - _ID
_
Tank to Dist. Box ' 'c Q
Dist. Box to Field/P' " A 71"
Openings Sealed? es No Partial
LOCATION/SEPARATI
Foundation to Tank ofeet
Foundation to Absorption 77E7 feet
Separation o Pits eet
Conforms as per Plot P1 an Yes ., No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - eft Sides Right Side
Middle Front - Mi eRear
COMMENTS:
--j`z�G't.,4- 0. . 0c a , 11. to fir'
SA)— 00' ,— le ) /G _
(1..) ‘-Lt .-- /M94 1 4T I 6-it)SI '— 6 K
SYSTEM USE APPROVED: � NO C
Arrived:
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name k! U)1
Location /fU,,,as1,./
Date 0 7-07 ; Permit # 1
SOIL TYPE: Sand-Loam-Clay- 0(3—5j
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 Typ
Bldg. to Tank
Tank to D. Box
Dist. x to Field/Pit
Op ings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption _ feet
Separation o+ 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:
dim CAI< - `"r ' �)Er iiicklcz.
SYSTEM USE APPROVED: YES ( NO)
Arrived: -�
Departed: -
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 6/�G--4v e/-1 (,mil r'r
Location L/.4.4--it/
Date 87//41/6 Permit # igiO6
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each tr ch
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 P1 an Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
614 . - R �
i r /'1u,v g Ci? 30440.
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector
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TOWN OF QUEENS3l1RY BUILDING pEPARTM�NT b�
Based on our limited examination, -
compliance with our comments shall �, <
not p construed
as indicating the �- .� � -'% ;22/
/'�' `plans and specifications are in fulli�mpliance with the code. i � �ice✓ ! /`� !�
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