1999-457 CERTIFICATI'J OFCOMPLIANCE
TOWN Or QUEENSBURY
WARREN ,COUNTY; NEW YORK•
Date July 26 19, 99
�j
M, 1 '� ✓ Le
9957.,
T is is 1o' certify. that work request q ed to be done• as shown by Permit No
has been completed.
SEPTIC SYSTEM'!
This structure may be used as a •
Location 31 INTERGREEN
Owner DALEY, JOHN & ANN•
• 1. r -.. � . i
TAX' MAP NO: 119 —5.-7 : By Order of Town Board
- , -' . TOWN OF QUfENSBURy :.. . , - • •
Director of Building & Code Enforceme►\\f
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 99457
TAX MAP NO. 119 . —5-7 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to DALEY, JOHN & .ANN
OWNER of property located at 31 WINTERGREEN RD_ Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC SYSTEM.
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
• 31 WINTERGREEN RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address -
DAN DRELLOS , PO BOX 224
'GLENS ._FALLS.-.NY . 12801
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( I Masonry ( )Steel I
7. PLANS and Specifications
SEPTPO SYSTEM AS PER PLOT PLAN AND SPECIFICATIONS .
3 BEDROOM, RESIDENTIAL
8. Proposed Use
SEPTIC SYSTEM
July 2.7 - 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.)
27 July lg _ 1999 -
Dated at the Town of Queensbury this Day of
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of 99457 119 . -5-7
DALEY, JOHN & ANN Permit No. .Dept. of Commuai.: : 31.•WINTERGREEN RD ` '�
Building'&Codes'' . ''SEPTIC SYSTEM ��
• 742 Bay Road I Fee Paid $
QuePrsbuyy, NY L. 2.V:: _
,
Location of property for installation:3/ t to>7"6i ..9 L ea.,/ #10
Property Owner's Name: h/i A _-e/
7 _ JUL 2 6 1999
.... Property Owner' Mailing Address: / s,J�c.9 PA" e
/1 I Uvviv u-uu„NSBURY
Installer's Name: •f-sc/1 T/,ti Gl F c Phone # '9 u t_ 'i COPE
. Number of bedrooms (if residential): 3 Total daily flow: i j6-D
(residential -compute @ 150 gal./bdrm.) _
Topography: flat, rolling, steep slope % of slope
• • Soil Nature: °L 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 1
Domestic water supply: . ,L.,municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. .•
PROPOSED SYSTEM
/L f(.pG,az e...r- 6"67
.Septic tank I 00U gallon (minimum•size: 1,000 gal.)
Tile field:' each trench /J/Meet / Total system length: ' feet
Seepage pit(s): number of /0/," / 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
e
Alarm system and associated electrical cork to be impacted by a certified agency.) •
s. ;f.iForlyou{pootec n, please note that pursuant to Section 136-29 of the Code of the Town of Qaeeasbary, any permit or
.,.;,:.; appaoval:granted which is baed,upon or is granted in reliance upon any material or failure to make a
:-'; ``.mpte u+l'fict or ciicamstaace'known by or on behalf of an applicant;shall be void.
' .;-- .
•I hive read this regulations a+ith and agree to abide by these and all requirements of the Town of
Queeasbury'Sanitary Sewage •• • •• .. ., r
Signature of responsible perso. Date: 2-'
li)411)
TOWN OF QUEENSBURY
BUILD 4 a ODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
V22_\_)
Name "� "1^
Location
Date Permit #
SOIL TYPE: Sand- oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length _
Length of each trench
Depth of trenches I i
Size of stone ) /
SEEPAGE PITS: Number'_
Size - , ft.
Stone Size--_f i
PIPING: Si e Type
Bldg. to Tank �` )
Tank to Dist. Box L1 5
Dist. Box to Fiel
Openings Sealed? /gipNo Partial
LOCATION/SEPARATION . 9r71
Foundation to Tank pV feet
Foundation to Absorption feet
Separation of Pits, feet
Conforms as per Plot Plan Ka No
LOCATION OF SYSTEM ON PROPER'741111,
(circle
Front - TlIff - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
ICNNV. FGict oNc j
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector ector
1
ytj .(.4&.-� (Le- (LO
cp.4.57
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4
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���� Based on our ll,•r;; CI:x.;;,s; •- ;._t•;'.'° I"
compliance with our corn;;,;,;.,..,.;ll
not be construe^' . irall.
:.:.r,,,! o„tic itt{,
plans and soeci;;,r<;tiL,,s'are'i;;1uil
Jcomplia;rci� .;rih the co.:: .
TOWN k_ 1,Y,EEs°,,5S.;-BURY
UILD N. & OD'�e T.
REVIEWED BY
DATE
`1 have seen or observed, or believe I saw evidence of,
' objects such as houses, wells, trees, fences, etc.,
,nuwn on this document. I also r present that I have
'qe on IIy measure ,t dist n s set forth on t e diagram."
• SIGN R DA E