96-107 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBU.RY
WARREN COUNTY, NEW YORK
Date June 2 19 97
96107
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may" be used as arTi ALTERATION
Location MASON ROAD
Owner AI'4IRS.A.LEF-I, MAHYAR & FRAN
By Order of Town Board
TAX MAP NO.. 13, —1--25 " OF QUEENSB Y
Director,of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 96107
TAX MAP NO. 13. -1-25
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to AMIRSALEH, MAHYAR & FRAN
MASON ROAD
OWNER of property located at 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
P.O. BOX 220
ALPINE, NJ 07620
2. CONTRACTOR or BUILDER'S Name
CRANDALL, CHRIS
3. CONTRACTOR or BUILDER'S Address
R.D. #1, BOX 1376
LAKE GEORGE, NEW YORK 12845
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( 1 Masonry ( ) Steel ( )
7. PLANS and Specifications
SEPTIep•ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES April 10 19 98
(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 10 Day of April 19 96
SIGNED BY ITE�� c n for the Town of Queensbury
Building and Zoning Inspector
H
Application for SEPTIC DISPOSAL PERMIT' 0
SI'AMI' RECEIVED Z
Location of property for installation: C 1 "0361A- 62\e) •1
owner's Name: n r ` ► Vn,- -f-AewI4'I 14.81-1-Ze ! PERMIT NUMBER 1
Owner's Mailing9(040 Address:
rrl
I'FEE
C� S CaflLI All) Z
Name:installer's Nuc: �� i'hon �c #: 4 3`d`T 3 1 c.")
(11
Eixc(Luckfir — 7q.u-0072
Number of bedrooms (if residential):
Total daily flow (residential -compute @ 15(1 gal. per bedroom): �`'v }�� N. __
VUJJ 1 Imo- r��4 i„�,I yJr Ir- ', �
Topography: [�J Hat 1 I Rolling I I Steep Slope ^,1• of Slolic
Soil Nature: IN'Sand n Loam Clay Other /1)cptlfl PR 1 0 1°96
Ground Water: at what depth? Ail &ldt.u1 I V 1 feet TOWN N OFCrEiF',_ ! `3URY
FB1J1wl_tlNG AND CODE
Bedrock or Impervious Material: at what depth? 410AI1/7 feet 4 1 4-
Percolation Pest: I 1 Not Required I /1 Required/Rate '5 min. per inch
Domestic Water Supply: - I 1 Municipal 1 I Well Other Laic
If domestic water supply is a 1Vi1..1.: water supply from any septic absorption is feet
PROPOSED SYSTEM:
Septic tank:_gal. (minimum size: 1,00(1 gal.)
5i Co'_
'tile Field: each trench 1/tO0 feet. / total system length 3o feet.
35 °' /
Seepage Pit(s): number of / size each:.,,,,,,-/----.11. x f ft.
Size of stone to he used: # / depth or thickness I feet.
HOLDING 'TANK SYSTEM: or required)
Number of links: Size of each: / gal.
1: Alarm .system and associated electrical.work to be inspected by a certified agency.
For your proi'ecaliarr, please note that pursuant to .Sec:tion 136-29 ofthe ('ode of the Ion•rr of
Quecnsbtuy, any permit orappror'al granted which is based Upon or is granted in reliance upon
any material misrepresentation or frrilruc to make a material filet or circumstance known by or on
behalf of an applicant, shall be void.
1 have read the regulations with respect to this application and agree to abide by these and all
requirements o f the Town o f Qrreerr.sbrrr•v Scrnitar . ,Savage Disposal Ordinance. `
Signature of respon.sib'e person: Date:
PiV\
•
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name4Ak0-e _Sd,le./.._
Location _ 1,--
-gi 01,-4,46
Date 64 q'7 Permit # iiN
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rafe-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To engt
Length of each trenc
Depth of trenches
Size of stone
SEEPAGE PITS: N ber-
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 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: b/'0
Departed:
Building4/
I e o
nspe�tor
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARIWCO DEPARTWZ 7 I
REQUEST FOR INSPECTION RECEIVED:
NAME
LOCATION {t,\c)0 l cy )
DATE (n r PERMIT i -I(C?-r l
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBL
PROVIDING PROTE TION FROM '• •Er
FOR 48 HOURS FOLLOWING PLA
MENT OF THE CONC.-
MATERIALS FOR THIS PURPOSE ON TE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB '
FRAMING: _
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
171.)
FOUNDATION WALLS INTERIOR R-v
-
FOUNDATION WALLS EXTERIOR R-
FLOORS R- 2r
WALLS �T �i-l�'7 R- '�`I
CEILING p,l..Ct1 It' 4: R- 7
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
FI(2-87-
F()0 1W i Mc is
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name /%(-- ,,/4i/. ;/
Location /,iyiew c
Date l,t�% C Permit # � � Jl1�../07
SOIL TYPE: d Loam-Clay-
Results of Percolation T-s -
(if applicable) Rate-Min ' e/Inch _-
TYPE OF SYSTEM:
ABSORPTION FIELD: T. al en th WO
Length of each tr: ch ,./4 i,,•
Depth of trench: 11W, 4
Size of stone ,-
SEEPAGE : Number-
Size - ft. Vi /i ft.
Stone size // )--
PIPING: • Size Type -
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit ,, /e v'
• Openings Sealed? ' No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption _ feet
Separation of Pits _ feet
Conforms as per Plot P1 an Y No
LOCATION OF SYSTEM ON PROPERT
(circle one
Front - ar .- efided Right Side
Middle Pr t - - i Si-dda-e—R-ea r
COMMENTS:
' • S--. f2 -/j- ." //0 /S/
•
Fir. f�/ 004i-i:Je4.``;
•
SYSTEM USE APPROVED: 1' NO
Arrived: :51L 3 -
Departed:
Building Inspector
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