1999-179 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date April. 28 9 99
30
141,0
i
99179
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
33 HEINRICK,'CIRCLE
Location ; ' •
Owner WHITEHEAD, ROBERT• "&,
•
TAX MAP NO, 90 . -.4-20 By Order of Town. Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
• BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 99179
TAX MAP NO. 90. —4-20 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to WHITEHEAD, ROBERT &
OWNER of property located at 33 HEINRICK CIRCLE 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. OWNERS Address is
VIVIAN 33 HEINRICK CIRCLE
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name,
QUEENSBURY QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address.
JAY SWEET
0
4. ARCHITECTS Name
5. ARCHITECT%Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
)Wood Frame ( )Masonry ( I Steel ( I
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 April 26 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 Queensbury before the expiration date.)
April 1999
Dated at the Town of Queensbury this 26Day of 19
SIGNED BY for the Town of Queensbury
Building Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT"
Town of Queensbury -
/7/
'Dept. of Community Development Permit No.
Building &Codes Office �'�, �Q/
742 Bay Road Fee Paid `J
Qu_ensbury, NY 12804
Location of property for installation: He 11 rl L C i re,
Property Owner's Name: IA) 1- e �A -e--ok sue;E C E IVE D
rc
Property Owner's Mailing Address: a yn -e APR 2 6 1999
w gaG
UEENBBORY
Installer's Name: E,e US Vat--
at-- SQ•� Phone #
AND CODE
Number of bedrooms (if residential): Total dPi1y flow: 6 Cr
(residential - compute @ 150 gal./bdrm.)
Topography: )( flat, rolling, steep slope % of slope
- Soil Nature: X sand, loam, clay, other/depth:
• Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, re uir ed [rate min. per inch]
Domestic water supply: 'K municipal, well, other
If domestic water supply is a WFT J , water supply from any septic absorption is feet.
PROPOSED SYSTEM
•
Sr �csz
Septic tank: gallon (minimum size: 1,000 sal.)
Tile field: each trench feet / Total system length: ,•Z Sr-) feet
Seepage pit(s):'number of / size each: , ft.by ft.
K
Size of stone to be used: # .2.-- / depth or thickness eel
HOLDING TANK SYSTEM: (if required)
Number of tanks: '• Size of each: gallons
&Ls=system and associated electrical Rork to be inspected by a certified agency.)
For your r protection, please note that pursuant to Section 136-29 of the Coda of the Town of Queeasbury, any permit or
approval gra-' 1 which is based upon or is granted in reliance won any material misrepresentation or failure to make a
material fact or circumstance Known by or on behalf of an applicant, 0v+11 be void.
I have d the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queers wy Sanitary Sewage Disposal • .
Si?at-are of responsible person: Date: '
:_____\'' 0 L------ /____ 84-i,r
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMEN
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name //L*4' ke_n0
Location _ �3 #3/1,01Ck C :1eiZ,<..
Date Aii/f )5 Permit # 974791
SOIL TYPE: Sand-Loam-Clay-
Results of Perc. .1.9n Test-
(if applicable, Rate-'Minute/Inch
TYPE OF SYSTE1
ABSORPTION F' LD: Tot l Length
ength of e.ch trench
Depth of tfenches
Size of--s- .-e- -'�
SEEPAGE Pi TS: Number-
Size - ft. x ft.
Stone si'e
PIPING: Size Type
Bldg. o Tank
Tank. io Dist. Box
Dist. Box to Field/Pit
Open ngs Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption 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 - Middle Rear
COMMENTS:
•
SYSTEM USE APPROVED: YES 0
Arrived:
Departed: I , o3
9
Building Inspector
2 ` 0
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name eiLY‘kci-VAAD
Location 575 1 c1/4) i2 c CAPS--
Date 83 2 Permit # Gm- 1,-7 61
SOIL TYP . San Loam-Clay-
Results of Percolation -st-
(if applicable) Rate-) inut:/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Ti al Leng l?�?-5,�
Length of each tren, h ( —
Depth of troches
Size of ston: Taigiir
SEEPAGE PITS: Numi
Size - . ft.
Stone size -
PIPING: Sizp Type
Bldg. to Tank 1/1 �1'
Tank to Dist. Box11 7G►r,) ()
Dist. Box to Field4 '" U
Openings Sealed? No Partial
LOCATION/SEPARATIO .
Foundation to Tank feet
Foundation to Absorption 9-U feet
Separation of Pits eet
Conforms as per Plot Plan * - No
LOCATION OF SYSTEM ON PROPER .
(circle
Front Rea, - Left Side Right 4--', -
Middle ront - Middle Rear
COMMENTS:
•
SYSTEM USE APPROVED y1111
NO
Arrived: _1 ,�k
Departed: ;L�
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Building Inspector ector
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\ , ({j�/NN O i I c, V. f 1/�,.'11{,`i�./..•.E�11),.JLrt'y(11'�{f 41LF�1
o used on our IimitGll C J1Jt11�1 cut�Vl�;
0 0 mpliance with our comments stall ;EC E�V
a not be construed as indicating the
plans nd specifications care In foil APR 2 6 1999
vomplia e with the cza:.
TOWN OF QUEENSBU1R"
BUILDING AtaD co
TOWN OF QU ENS J Y
BUILDING &
"I have seen or observed, or believe I saw evidence of,
REVIEWED BY all objects such as houses, wells, trees, fences, etc.,
DATE f shown on this document. I also represent that I have
pe o•. ly measured the diltances set forth on the diagram."
` 'may./ -. , i L-—
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----pr 1 J c v..) 0- SIG ATURE
DATE