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95-216 (2) , CERTIFIC, TE OF COMPLIANCE TOWN OF .Q`UEENSBURY WARREN, COUNTY, NEW. YORK • Date Septembel: 25 '19 96 95216 •Thi s 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 SYSTEM Location , • By Order of Town Board • A .tiTAP go` 1 6 ' 7 1-t;r TOWN. OF QUEENSBURY '0/ f 94 .7 Director of Building & Code Enforcement Y BUILDING" PERMIT VALUE $ 0 'TOWN OF. - QUE-ENSBURY= - rr::,h: .._.:::-.. 95216 : TAX MAP NO. 16. —1-17- .r No. WARREN COUNTY, NEW YORK GREENE, ELEANOR M. PERMISSION is hereby granted to 73 SEELEY RD. OWNER of property Iocated,at Street,Road or Ave. in the Town of Queensbury,To Construct or place a SEPTIC SYSTEM -_ 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 BOX. 73., • . . ;. 4 CLEVERDALE N:Y =-12820, 2. CONTRACTOR or BUILDER'S Name ROULIER, JOE 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications • SEPT Ie•SYSTEM TO INCLUDE: 1250 GAL. TANK US;ING.> -300' . . FIELD—AS,==P-ER..PLO.T..-_PLAN SPECIFICATIONS=:,,.-_ 8. Proposed Use SEPTIC. SYSTEM _. . - - - i . - - (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 _ f D'ay of 19 SIGNED BY for the Town of Queensbury Building and Zoning In :ctor nplication for - t; S E PTIC DISPOSAL PERMIT STAMP RF3C11 VFD Location of property for,Jnstallation: ...5-ez , / &,,,,iCc. ,,,./ PFRMI'1'NUMIIEIi Owner's Name:. o--s ��e�� " ,;«� Address: A-t s1 , 1:77-,« — rf e'.0 3 35-e - �.a,,ote... '1 ' s-.4ol"n/. s��.? D3.2e3 Installer's Name: . �,,"Gc. r ' FEI PAID 45 00 Phone #: ( ) 4 J'e••- ..34-5'Y Number of bedrooms (if residential): 7 /1p/ , 1 ' r ' 7 Total daily Bow (residential -compute @ 150 gal. per bedroom): Ge-a- Topography: [ Flat ri Rolling I I Steep Slope % of Slope Soil Nature: I Y I Sand n Loam I Clay Other /Depth: f Ground Water: at what depth? lS feet • Bedrock or Impervious Material: at what depth? N� feet Percolation Test: r1 Not Required r, Required/Rate min. per inch Dome � � stic Water Supply: I-1 Municipal � Well 1 Other .4pe,c 4-//�� �-7 c- if domestic water supply is a WELL: water supply from any septic absorption is feet PROPOSED SYSTEM: - Septic lank:/•13 c gal. (minimum size: .1.000 gal.) Tile Field: each trench e 4 feet. / total system length -J feet. Seepage Pit(s): number of / size each: ft. x ft RECEI\i „ Size of stone to be used: # MAYf / depth or thickness feet. 0 51995 IiOLDING 'TANK SYSTEM: (if required) TOWN OFQUEENSBURy BUILDING AND CODE Number of tanks: Size of each: gal. 11 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. 1 have read the regulations with respect to this application and agree to abide by these and all requirements of the Town o f Queensbury Sanitary Sewage Disposal Ordinance. - Sienattrre o f responsible pets _ -- Date: .S� �s 5 i TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury WY 12804 518-745-4447 . SEPTIC DISPOSAL SYSTEM INSPECTION , Name �I Location Date , Permit -_ SOIL TYP : Sand-Loam-Cla - Results of Per olation est- (if applicable Rate-Mi ute/Inch TYPE OF SYSTEM ABSORPTION FIEL : Total Length Length of each rench Depth of trenche Size of stone SEEPAGE PITS: Nu ber- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/P Openings Sealed? es No Partial LOCATION/SEPARATION : Foundation to Tank ' feet Foundation to Abso ption feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYS ON P'OPERTY: (circle on- Front - 'ear - Le t Side Right Side Middle Front - Middle Rea COMMENTS: /790-vreat • ;1 /Orel 4- Q r/-ed,---I:\of SYSTEM USE APPROVED: 4:10 NO Arrived: Departed: Building In ector O E (518)656-3544 JR0uLI ER, INC. BOX 301,CLEVERDALE,N.Y.12820 �s �p '°' (72,........ � •" TOWN OF QUEENSBURY BUILDING DEPARTMENT Nei �G-s ,,,,�.��., .so„� Based on our limited examination, f 7 — compliance with our comments shall 6 - ` '--� - -.•a .o 1•- not be construed as indicating the plans and specifications are in full ,“/ -r.07c., compliance with the code. N Aco ' :I, a \ '7a L �-�d4 o60 TOWN OF JQNpUY L„OTP PIPE "16$ o 13'.I'ILD N of2 AAA tit o evl v 'Fear A6C RE 1EWE® B DATE �,gf��'/ f .v / 20 RECEIVED MAY 0 51995 , TOWN OF QUEENSBURY ++ ., �.r r� .. BUILDING AND CODE .. - - F1E COPY ^ - ,)----' ..., J 5--/ , ;