95-149 CERTIFICNPE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date i 1 14 19 9 5
95149
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be used as a SEPTIC
Location 11. IHOODCREST DRIVIE
Owner GREEN1100D , BRIAN SUB,
By Order of Town Board
TOWN OF QU,.EENSBURY
IS
V-
Director of Building & Code Enforcement
BUILDING PERMIT -
VALUE $ 0 TOWN OF QUEENSBURY " No. 95149
TAX MAP NO. -85. -1-7. 70
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to GREENWOOD, BRIAN & SUE
OWNER of property located at - 11 WOODCREST DRIVE 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
11 -WOODCREST DRIVE
QUEENSBURY. NY 12804
2. CONTRACTOR or BUI LDER'S Name
SANITARY SEWER
3. CONTRACTOR or BUILDER'S Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY- 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( 1 Steel ( )
7. PLANS and Specifications
S-EPM- ALTERATION AS PER PLOT PLAN SPECIFICATION
8. Proposed Use
SEPTIC ALTERATION
$ 25 - PERMIT FEE PAID--THIS PERMIT "EXPIRES April 3 19 97
(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 14 Day of April 19 95
SIGNED BY for the Town of Queensbury.
Building and Zon. I nspector
Application for SEPTIC DISPOSAL PERMIT �
APR 121995
Location of property for installation:
�vvofc�r�es: a •_
Owners Name �2rA•l? r/y CRQ2iy�J97 �jLd
Owner's Mailing Address: ` 6U00p 04ez, 2ti
�� rra All) GAO- T
Installer's Nance:`"�N 1�� laL'I'( I'Ironc 9a?ds7
4
Number of bedrooms(if residential):
C
Total daily flow(residential -compute (Rp 1.10 gal. per Bedroom):
'i'opogrnphy: pint Bolling �_] Steep Slope 3'n of Slolic
Soil Nature: [—Sand �] L,i�[im Q (:Iny L] UtherRd L /Depth:
Ground Water: at what depth? feel
Bedrock or Impervious Material: at what depth? feel
percolalion'I'est: E_Not Required Q Iicquircd/Kale min. per inch
Domestic Water Supply: i Municipal L] Well Other
If domestic water supply is'n W11*11..I: dater supply from any septic nbsorption is feet
' 1'itUl'OS["sl� SYS'1'1sM:
e
Septic tank:Q-0 gal. (mininttnn size: 1.000 gal.)
'lile field: each trench feet. / tolal system Icngllr feel.
Seepage 11il(s): number of 2 / size cacti:Jc� fl. x fl.
Size of'sume to be used: ay _J / depth or thickness 2— feet.
1101A INO TANK SYST11m: (if required)
Number of tanks: Size of each: g:il.
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note (ho pur•suma to Seiction 136-29 of tlA Code of the Town of
Queerrsbury, any permit or a pl'roval granted which is based upon or is granted in reliance upon
any material misrepresentatioir or fi+ilure to make a material fact or circumstance known by or on
behalfofan applicant, shall be void.
I have read the regulatiotrs wit respr t this a pplicalion and agree to abide by these and all
regnirenrent.s o f the Town of( rreensl ury Sanitary Sell-( Uisposr I Ordinance.
Signature o f responsiVe person: Date:
I Nve seen'
�n or obsery
; Ie.ts such as ► or believe I saw evidence of
c oases, wells tr on ,s r.10 6s, fences, etc.,
meet: I also re ec p �u,r�31)Y ease ed t e d-'tan t at I have
s e .or on th diagr
\j �--
SIGiVA
DATE r
81 Q
e' TOWN,OF QUEENSSURY BUILDING DEPARTMENT �
Based on our limited examination,
lkt compliance With our comments shall
not be construed as indicating the
plans and specifications are in full
d compliance with the code.
V\
`u
4G
4 lei;'1z,y
.d�_� D U P f1 0
TON€V OF QUEENSBURY
l �
,�PJILDING $ CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM NSPECTION
(t1f
oe64)
Name - O&S
Location e-
Datee it
SOIL TYPE: and-Loa Clay- —
Results of lercola ion Test-
(if applica le) R e-Minute/Inch
TYPE OF SYS ESA:
ABSORPTION IELD- Total ngth
Length of a c}i I � ene
Depth of tr -Fr"s
Size of stop
SEEPAGE PITS Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Ta k ::��-,%,--)(Z-_>
Tank to Di Box
Dist. Box o f el d/Pi t WL (��{
Openings eai d? Ces No Partial
LOCATION/ EPA TIO
Foundati n to Tank feet
Foundation to bsorption _C feet
Separat on of its feet
Confo s as p Plot Plan es o
LOCAT OF S STEED ON PROPER :
(circ a one
Fro - Left Sid Right Side
Mid root - e ear
CO ENTS:
i
SYSTEM USE APPROVED: YES NO
Arrived:
;De
p .r ed•
Buy i Inspector