2000-007 {
CERTIFICATE OF COMPLIANCE
._TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
date January, 12 . 2000 jj
t4 r
MGM
This is to certify that work requested to be done as shown by Permit No.
has been completed. SEPTIC ALTERATION
This structure ma be used as a
283 C RINTH RD. —
Location
Owner
TAX MAP NO. 127 . -8-23 By Order of Town Board
. TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
VALUE $ 0 20@0@07
.TAX MAP NO. 12 7 . -8-2 3 Building Permit No.
. Permission is hereby granted to JOHNSON, THOMAS & LAUREL
283 CORINTH RD.
Owner of property located at
in the Town of Queensbury, SEPTIC ALTERATION
Qu ury,to construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
2e66Af1 RD.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
I .B. S. SEPTIC
Contractor or Builder's Address:
2 LOWER WARREN STREET_
QUEENSBURY, NY 12804
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
Proposed Use:
SEPTIC ALTERATION
25 January 5 2002
$ PERMIT FEE P�—THIS PERMIT EXPIRES
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury5 this Day of January 2000
SIGNED BY JeA for the Town of Queensbury
Co orcement Officer
Application for SEPTIC DISPOSAL PERMIT
To;,n of Queensbury RECEIVED Permit No.
Dept of Community Development
Bu:1dmg &Codes Office JAN 0 5 2000
742 Day Road Fee Paid
Quee sbury, IvY 12804 OP O'U`ENi'33URY
BUILDiNG
Location of property for installation: �/) r r�A•i! � �^
Property Owner's Name: "10 •'` 5
Property Owner's Mailing Address: 11,'.v / 4 1 (3)
Installer's Name: 1), % Phone ;r ��—�1� Y
Number of bedrooms (if residential): Total daily flow: ��
(residential - compute @ 150 gal./bdrm.)
Topography: (� t?at, rolling, steep slope I of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at*,,ct depths y/q feet / B e�-ock or Impervious Nfaterii: at w4at depth? ! feet
Percolation test/Vk not require_, re uired [rate min. per inch j
Domestic water supply: municipal, well, other
H domestic water suvoly is a WELL, water s7-=ly uorri any septid absorption is feet.
PROPOSED SYSTEM
Septic tank./L011 gallon (n ini„urn size: LOGO sal.)
Tile field: each tench feet I Total system Iength: feet
Seepage pit(s): number of � I size each: . fL by fL
Size of stone to be used: _ / de-oth or thickness f feet
H OLDR 1G TANK SYSTEM: (if required)
Number of tow-: Size of each a noas
Alarm system and associated electrical work- to be aspected by a certrned agency.
For-,c;r protection, please note that pursuant to Section 136-29 of the Code of the Town of Qoeewbury, any pew or
arp----v l -armed which is based won or is guanted in reH=ca t on asy mzterial roisrepresec'n or failure to mike a
mate: I .`a.• or cir urnstance 1-noan by or oa behalf of on applicaz;t, shall be Void.
I have ._.ad the regulations with respect to this avplic 'on and a_o•-ee to abide by these and all:D�mrexnents of the Town of
Que,e-.s�u-,y Sanitary Sewage Disposal Ordnance.
Sij a~,re of responsible person: Date:
TOWN OF QUEENSBURY
BUILDING_& CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12864
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location M1
Date 11ate
t J�
�l..o�—' NCO
7
SOIL TY Sand
Results of Perc Tes -
(if applicable) nut /InchTYPE OF SYSTEM:
ABSORPTION FIEL Le gthLength of each '
Depth of trench
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/ it
Openings Sealed? Yes No . .Far tial
LOCATION/SEPARATIO
Foundation to Tank feet
Foundation to Abso ption 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 - Mi dd Rear
COMMENTS-
SYSTEM USE APPRO NO
Arriv
Dep ted-
Bui] i n' n pector
TOM OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
'142 Bay Road
Queensbury NY 12804 w
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
D a t __S 1Permit # (��(���
SOIL TYP San - am-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTIOW FIELD: Tot 1 kength
Length of a ch `trenc
7
Depth of tr% hes
Size of stone
SEEPAGE PITS: N
Size - ft. x ft.
Stone s�"zF �7 �. ��� L
PIPING: Size Type
Bldg. to Tank C+�tS�tt
Tank to Dist. Box No .
Dist. Box to Field testa ��
Openings Sealed? es No . ,Partd1
LOCATION/SEPARATIO S:
Foundation to Tank 'r feet
Foundation to Abso ption �L;i +: feet .
Separation of Pit �,�-� feet..
Conforms as per P of Plan Yes No
LOCATION OF :CYST M ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle F n - Middle Rear
COMMENTS: -
i
SYSTEM.USE APPROVED: YES, NOy
Arrived:
Depart
g sp t
S
01/12/2000 12:32 7983213 „ IBS PAGE 02
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