1999-005 • .
Certificate of • Compliance
Town of Queensbury ,•
Warren County,New York
January 6 99
Date
:C)6\ :\t?
99005
This is to certify that work requested to be done as shown by Permit No. •
has been completed.
SEPTIC ALTERATION
This structure may be used as a
49 CORINTH RD.
Location
•
Owner STEPAN, SHELLEY.
TAX MAP NO. 127 . -11-10
By Order Town Board
TOr-OF-QUEEN>yBl.jyy ---- •
Director of Building& Code Enforcement
}.
BUILDING PERMIT
1441 ,'se TOWN OF QUEENSBURY
VALUE $ 0 No. 99005
TAX MAP NO. 127 . -11-10 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to STEPAN, SHELLEY.
OWNER of property located at 494 CORINTH RD. Street,Road or Ave.
in the Town of Queensbury,To Constructor 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
• 248 CORINTH RD.
QUEENSBURY,. NY 12804
2. CONTRACTOR or BUILDERS Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDERS Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
4.ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate byX)
SEPTIC
( )Wood Frame ( I Masonry ( )Steel I )
7. PLANS and Specifications
SEPTICNgA1LTERATION AS PER PLOT PLAN SPECIFICATIONS.
8. Proposed Use.
SEPTIC ALTERATION
25 January 5 ��000
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(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 dated
5 January 19 1998
Dated at the Town of Queensbury this Day of
SIGNED BY for the Town of Queensbury
Buil mg and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury it No. 1
Dept. of Community Development Perm -0
Building &Codes Office c
742 Bay Road Fee Paid ,
Queensbury, NY 12804
Location of property for installation: 7;# ft Co f/ 'mot
c
Property Owner's Name: a/ c n
. Property Owner's Mailing Address:, # G f
Installer's Name: J� , f . S"1O?# Phone # 79r- r/i2?‘
. Number of bedrooms (if residential): ' 3 Total daily flow:
(residential - compute @ 150 gal:/bdrm.)
Topography: t, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth? Jt / Bedrock or Impervious Material: at what depth? feet
Percolation test: Kot required, required [rate min. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank7'06 gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CA1m 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 Queens/bury, 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 app' ati.pn and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal • .6„ee_
Signature of responsible person: l' Date:
- TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Pt tcl-keIRO t6TEB2 C
Location 2-L ? CnRu iTh RtFP
Date 1 —( 99 Permit # 99—Mc
SOIL TYPE:aan :. oam-Cl .
Results of Percolati9n Test-
(if applicable) Ra --Minute/.'nch
TYPE OF SYSTEM:
ABSORPTION FIELD• Total •ngth
Length of each 'rench
Depth of "t enc es
Size of ston:
SEEPAGE PIT': Number-
Size - ft. x ft.
Stone siz'
PIPING: Size Type
Bldg. tr, 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 474ii No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
P€cF tN(ED A-BO1LT FoR
c6i3frriC-TB10111 LOCMTDII3
SYSTEM USE APPROVED: 400, NO
Arrived: if
Depart- I it
if
:u; 'ding 7 . •ctor
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i •
J' ' h M�°') 0he•
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a4 • •
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TOWN OF QUEENSBURY .
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name P\'11laNi S14?4,rifv-N
Location '] L Czyi (N14,.. RC)
Date \ - S 61 d Permit
SOIL TYPE: Sand ..m-Clay-
Results o' Periolatip Test-
(if applicable Rate-N\inute/Inch
TYPE OF SYS' E '-
ABSORPTION F. 'LD: Tota Length
Length of eac roc.
Depth of tre,ch-
Size of sto e
SEEPAGE PI ' : Number-
Size - ft. x ft.
Stone si e
PIPING: Size Type
Bldg. o Tank ti� C
-v\z-;177: 7-.p!". 5R2-6
Tank to Digit --Boxyr . y .g%
Dist. Box to Fieid7Pi1
Openings Sealed? (1:-Yes_.-> Partial
LOCATI Oil/SEPARATI Off: .
Foundation to Tank VI feet
Foundation to Absorption yfeet
Separation of Pits _ -- feet
Conforms as per Plot Plan Yes
LOCATION OF SYSTEM ON PROPERTY: p_9 _`' '
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS: ODD C�U�
3E �. EPTI> - �Vc
SYSTEM USE APPROVED: YES (NO _J .
Arrive - Z .
Depar ed: a L
9
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