98-290 f
CERTIFICATE OF COMPLIANCE
TOWN OF UUEENSBURY
WARREN COUNTY, NEW YORK
Date ,Tune 3 19 98
98290
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 ALTERATION'
Location 111 AVIATION RD.
Owner BA.RSUKOFF, IVANN &. SANE
By Order of Town Board
TAX MAP NO. 82 . -5-19 - TOWN OF 'QUEENSBURY
J
Director of Building & Code Enforcement
.,. lication Tor arr 1 iL LlaruJAL Yt✓KMl"l
Town of Queensbury
Dept. of Community Development Permit No.
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
_.__ ,.,, ,,.� -; --�;;•;(fir�{--��JILIJI 9 „_„, i��.�.ley
Location of property for installation: �p 2
JUN ,10.11998
Property Owner's Name: i1 �
Property Owner's Mailing Address: 0 Z
Installer's Name: Phone #
Number of bedrooms (if residential): _� Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: V flat, rolling, steep slope % of slope
Soil Nature: _L'sand, loam, clay, other /depth:
Ground water: at what depth? feet, / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: I/ municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tankG94/5: gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of (_ / size each: ft. by %0 ft.
Size of stone to be used: # 3 / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: ±62E2 gallons
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 1.36-29 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: ,,l�p/ ,,f I k-MA i,�'/�I Date:
BUILDING PERMIT
TOWN. ,:OF QUEENSBURY.
No. - 982-90
TAX MAP NO. 82. —5-19 WARREN COUNTY;-NEW YORK
PERMISSION is hereby granted to BARSUKOFF, IVAN & JANE
OWNER of property located at 111 AVIATION RD. Street,Road or Ave.
in the Town of Oueensbury,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 0ueensbury Building and Zoning Ordinance.
1. Off E1�60 r CITY RD
HUDSOON FALLS, NY 12839
2. CONTRACTOR or,BUILDERS Name.
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5, ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
1 )Wood Frame ( )Masonry ( )Steel 1 1
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN ,SPECIFICATIONS
No.
8. Proposed Use
SEPTIC ALTERATION
25 June. 1 2000
$ 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 Queensbury before the expiration date.)
1 June 19
Dated at the Town of Queensbury this Day of 19.
SIGNED BY _ / for the Town of Oueensbury
Building and Zo n or
u
TOWNtl
...... .....
B U LD i
REVIEWED
DATE
MAY 2 9 1998
17 hm I I- 1111
2to Now*"
loud
. ...........
7i
If
TOWN OF QUEEKSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION!
Name
Location
Date ermi t #
SOIL TYPE: Sand-Loam-Clay-
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 s ne
SEEPAGE PIT r-
Size - t. x y, f t.
Stone size 3
PIPING: Size Type
Bldg. to ank �
Tank t Dist. Box 't
Dist. Box to Field/Pi �- !- SICK
Openings Sealed? a No Partial
LOCATION/SEPARATIONS:
Foundation to Tank 16 feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Y No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left fight Side
Middle Front - dle Re
COMMENTS: /,V, �f6
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: -�-'�—
Building Inspector
TORN OF QUEENSBURY JL-//q
BUILDING & CODE ENFORCEMENT firt'Ll
742 Bay Road C3
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name jlvm r SC_v
Location (_yTZ 11y i.V �'ccJ�n ,9j�
Date Permit
SOIL TYP Sarid- oam-Clay-
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 - L ft. x = f�
Stone size
PIPING: k
--Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/
Openings Sealed? a No Partial
LOCATION/SEPARATION
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ eet
Conforms as per Plot Plan a No
LOCATION OF SYSTEM ON PROPER
(circle
Front - Rea - Left Side - Right Side
Middle t - Middle Rear
COMMENTS:
1rT
SYSTEM USE APPROVED: OYESNO
Arrived: 6- •'all
Departed:
Building Inspector