1999-134 . , CERTIFICATE 'Oa! COMPLIANCE -
TOWN OF' UU;EENSBURY
WARREN COUNTY,; NEW: YORK' •
Date Apr i1 , .16 ' 0 . 99
•
• • , 99.134
This -is •to certify that work requested :to':be done- as shown by :Permit-No
,has been completed.., , - , • • •
-. SEPT LC ALTERATION • - .
- This structure may' be used as a,, . - • . -
.. ' = 13 NORTHUP Dig ,.
'Location ,
GREENE, .GitEGORY &
Owner' - . .
-,TAX MA.P NO. 101'. —2 .23 -, , By Order of Town '-Board ,
— TOWN,,.OF QU S RY
.: •• • Director• - of, Building & Code-'•Enforcement• -
.
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 99134
TAX MAP NO. 101 . -2-23 WARREN COUNTY; NEW'YORK
PERMISSION is hereby granted to GREENE, GREGORY &
OWNER of property located at 13 NORTHUP DR. 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 -
KATHLEEN 13 NORTHUP DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 LOWER WARREN STREET
QUEENSBURY, .NY 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ' ( )Steel ( I
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use .
SEPTIC ALTERATION
25 April 14 19 2001
$ 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 Oueensbury before the expiration date.)
14 Apr i1 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No.
Building & Codes Office O
742 Bay Road Fee Paid O ,
Queensbury, NY 12804
Location of property for installation: 4,?
Property Owner's Name: y c i r. RECEIVED
Property Owner's Mailing Address: l 3 /(/p r-1 r ()Pi c-c. APR 14 1999
Installer's Name: �i U. S/� f I �', Phone it UEENSBURY
AND CODE
Number of bedrooms (if residential): Total clail flow: GQ
Y d
J� (residential - compute @ 150 gal./bdrm.)
Topography: ?rat,flat, rolling, steep slope % of slope
• Soil Nature: (sand, loam, clay, other /depth:
Ground water: at what depth?A ' feet / Bedrock or Impervious Material: at what depth? feet
Percolation test:/ ' not requir , required [rate min. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WFT.T , water supply from any septic absorption is feet. •
PROPOSED SYSTEM
Septic tank:lADO gallon (minimum size: 1,000 bl.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of / / size each: . ft. by CO ft.
Size of stone to be used: #7—/ depth or thickness / feet •
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Aiann system anci associated electrical work to be inspected by a certified agency.
For yom-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 misreprea n 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 applic 'on and agree to abide by these and all requirements of the Town of
Queensberry Sanitary Sewage Disposal Ordinance.
(4"(4 --)12
Sib ature of responsible person: /' Date:
C_.
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 6 V (2
Location 1,3 K I ) DP_
D a tL1
Permit
SOIL TYPE: and-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OFISYSTEM:
ABSORPTION FIELI Total Length
Length of each - ch
Depth of trench-
Size of stone ,
SEEPAGE FITS: 'umbe -
Size - f.. . x ft.
Stone siz-
PIPING: Size Type
Bldg. to Ta,k
Tank to Dist. Bo
Dist. Box to Fiel3/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIMS:
Foundation to Tan feet
Foundation to Absorption feet
Separation of Pit- _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTElii ON PROPE
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
VECeA k;,-- 0\G.
SYSTEM USE APPROVED: :WO
Arrived:
Departed:
/:uil t•'. Inspec
illik
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Ge.CCt(.7, GLEE a
Location ) 0oV--rWj) DR%\IF
Date L I-- 1 L.( Permit # °n--All
3
SOIL TYPE.- San am=Clay-
Results of /.ercolation Test-
(if applica le) Rat: Mi ute/Inch
TYPE OF SYS M:
ABSORPTION F ELD: otal Length
Length of ea tr:nch
Depth of tren e
Size of stone
SEEPAGE PITS: '+umber-
Size - *! ft. x \ ' ft.
Stone size ��
PIPING:
Bldg. to T. ik Size Type
Tank to D'st. ( __. -
Di - - _ ' 1 d/Pi t 0 \*\( -
Openin -'s Sealed? �� No Partial
LOCATION/SEPARATION
Foundation to Tank \(> feet
Foundation to Absorption 7-() feet
Separation of Pits _ feet—)
Conforms as per Plot Plan Y s
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
r Rear =Left Side -
on Right Side
d-i Front - i e Rear
COMMENTS:
\k 14 .6 ---7)\)n—
SYSTEM USE APPROVED: --NO
Arrived:
Departed. �;� : /
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