1999-301 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY.
WARREN COUNTY, NEW YORK
Date June .:4 19
99
. 9930i
.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
Location '. . 37 HELEN` DR. ,
WASSERMAN,;, PATRICIA
Owner
TAX NAP NO: 90 -4-85 By Order of Town..Board
TOWN OF QUEENSBURY
Director of Building &'Code Enforcement
BUILDING PERMIT
VALUE $ .0 = : ` TOWN OF QUEENSBURY No. 99301
TAX MAP NO. 90. -4-85 WARREN COUNTY, NEW YORK.
PERMISSION is hereby granted to WASSERMAN, PATRICIA
OWNER of property located at 37 HELEN 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 -
37 HELEN DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
SIGNORELLI & SON .
3. CONTRACTOR or BUILDER'S Address
589 WEST MOUNTAIN- ROAD
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
•
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by Xl SEPTIC
( )Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTIC ALTERATION AS . PER PLOT PLAN SPECIFICATIONS .
8. Proposed Use
SEPTIC ALTERATION
25 June 1 2001
$ 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. 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
u ng and Zoning `spector
- Application for SEPTIC DISPOSAL PERMIT •
Town of Queensbury 9WASSE 93 01 NRMA9: 0PATR., =4-IC8 5IA 'eermit No 9 01f
Dept. of Community Del
r
Building &Codes Office
SEPTIC ALTERATION : I
742 Bay Road ^ O�
l - .- -ee Paid $ ✓'
Queensbury, NY I28o4
Location of property for.installation: 7 /� ,c�/4/Ue • - R E I Y
Property Owner's Name: P4-8/1 VATeeel f J U N 0 1 1999
/-- ��„2�� TOWN OF OUEEN56Ui3Y
Property Owner's Mailing Address: 3'7 EIUI�DI,NG AND CODE
Installer's Name: J 11Wo,e,e///' i"i'7 Phone # 7902% ge
. Number of bedrooms (if residential): 3 Total daily flow:
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
• Soil Nature: 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: municip , well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
•
Septic tank gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system Iength: , 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
(Alarm 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 Queer
approval which is based or is '• any permit or
ppro grantedupongranted in reliance upon any material misrepresentation or failure to make a
material fact or circumstance known by or on behalf of an applicant, chui1 be void.
I have read the regulations with respect to this application and abide these and all requirements of the Town of
Queensbury San;terry Sewage Disposal •
Signature of responsible person: Date:
TOWN OF QUEENSBURY 'BUILDING & CODE ENFORCEMENT `
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ttia Pi
Location ■e—(L r•S R •
Date (: ' Permit # cf.6f`3D(
SOIL TYPE: Sand-' oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To : Length aefd
Length of each trenc / 5D •
Depth of trenches
Size of stone at.
SEEPAGE PITS: Number-
Size - ft. 1 ft.
Stone size
PIPING: Sizes Type
Bldg. to Tank .�
Tank to Dist. Bo " dO
Dist. Box to Fiel •
Openings Sealed? es No Partial
LOCATION/SEPARATIO S.
Foundation to Tank feet
Foundation to Absorption C feet
Separation of Pit- feet
--Conforms as per Plot Plan No
LOCATION OF SYSTE ON PROPER'
(circle one'
Front Rear Left Side - Right Side
Middle •ront - Middle Rear
COMMENTS:
- � S — VICE oil
SYSTEM USE APPROVED: YES NO
Arrived: ,
Departed:
Building Inspector
r Q
I
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location t C&L.G.rs cR
Date c13177 Permit # 7q---soi
SOIL TYP : .SEA= hnd:- oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Le Mho
Length of each tre chi ; ti
Depth of. trenches j.
Size of stone
SEEPAGE PITS: Nu ber-
Size - \ ft / ft.
Stone size
PIPING: • Size Type
Bldg. to Tank
Tank to Dist. Bux
Dist. Box to Fi •ld/Pi .
Openings Sealed? No P tial
LOCATION/SEPA" 'IONS.
Foundation to Tank /// feet
Foundation to Absorption �' feet
Separation of Pits eet
r^.Conforms as per Plot Plan Ye No
LOCATION 0 SYSTEM ON PROPER .
(circle as )
Front - 'ear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS: • -r�ie'T-'AcC
A-4 - eullT
SYSTEM.USE APPROVED: YES 0
Arrived:
Departed: L 2-'....55
Building Inspector
iuwn ur QUEENSBURY 1
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 •
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location \—
Date L 9—D._- lC\ Permit #9(\— 3d1
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tota1-length
Length of each trench 1
Depth of trenches r1
Size of stone I;
SEEPAGE PITS: Number- I'
Size - ft. x / ft.
Stone size '
PIPING: ',1 ize Type
Bldg. to Tank °ate'` & -77
x/, uCv
Tank. to Dist. Box! 4 .11 -5`-'0
Dist. Box to Field/Pit
Openings Sealed? 'i' 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:
1 6/OK ID, b c5A)L.Y
•
•
k o o(.)�A 1-A-toR
L Aie
SYSTEM USE APPROVED: YES 10
Arrived:
Departed:
Building Inspector
J
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TO N OF QUEENSBURY S
W I
. BUILDING AND CODE
/
0 Ouse GAeik 66'
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IL- /o 1 Pt D�� �,, �►.J
1 t / "I have seen or observed,or believe I saw evidence of,
I all ohlect' such as houses, wells,trees,fences,etc.,
I shown on this document. I also repre t that I have
personall distant et forth on th diagram."
•g — ete—v-j-t-P-N'6- -----I---- j-L---. - - -
SI T E DATE
Si6,00,06-(i: taz6 f- NTG 702- /C