1999-601 •
�---- _ -
,CERTIFICATE OF COMPLIANCE
TOWN Or QUEENSBURY
WARREN COUNTY, NEW YORK
Date September: .2019 99 .
99601
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
495 SHERMAN AVE. --"
Location
Owner
YARTER, 'LOREN
TAX MAP NO. 120 a-1-6 By, Order of Town Board
TOWN 'OF QUEENSBURY
&//;"
Director of Building & Code Enforcement
BUILDING : PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 99601
TAX MAP NO. 120. -1-62 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
YARTER, LOREN
4 9 5 SHERMAN AVE. Street,Road or Ave.
OWNER of property located at
To Constructor lace a SEPTIC ALTERATION
in the Town of Oueensbury, p
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. @VIE 1 J AVE.
QUEENSBURY, NY 12804 .
2. CONTRACTOR or BUILDERS Name
CONDON'S..SEPTIC & DRAIN
3. CONTRACTOR or BUILDER'S Address
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address -
6. TYPE of Construction—(Please indicate by X) SEPTIC
( I Wood Frame I I Masonry ( 1 Steel ( 1
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT. PLAN. SPECIFICATIONS
No.
8. Proposed Use
SEPTIC ALTERATION
2b September 20 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.)
' 20 September 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY llv� for the Town of Oueensbury
Building and Zoning Inspector'
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Dept. of Community Development Permit No.
Building &Codes Office !_;E � VED
742 Bay Road Fee Paid `cam
Queensbury, NY 12804 SEP 1 `Z
1999
Towyopoc: 7.
Location of property for installationQRADZV A! h2A i s t
(
Property Owner's Name: L(7/ /Z/ A J E e
Property Owner's Mailing Address: 1 pricy/FA), ) ()iv A v F
- Installer's Name:(�1cid/U �' � ��v/'� 9� / Phone # 79/—t i yL-
Number of bedrooms (if residential): Total daily flow: I 6
(residential - compute @ 150 gal./bdrm.)
Topography: y flat, rolling, steep slope % of slope
- Soil Nature: X sand, loam, clay, other I depth:
f _
Ground water: at what depth? —feet / Bedrock or Impervious Material: at what depth'?2 feet
Percolation test: K not required, rewired. [rate min. per inch]
Domestic water supply: X municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM n urCr i /hcitot up le t-�-lS+1.vy i-f@cJ/ E/of
Septic tank, vgallon (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
Alarm system ard associated electrical work to be inspected by a certified agency.J
For your 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 misrepresentsfion 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 application and agree to abide by these and all requirements of the Town of
Queensbury Sanitsiry Sewage Disposal Ordinance.
Signature of responsible person: 11J Date: 9^/� " V9
TOWN OF QUEENSBURY
BUILDING .& CODE ENFORCEMENT
742 . Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 1hvQI'E-1
Location SF(diCWjA.,J:
Date zd Permit # O
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total L.:iiiiill
Length of each trench
Depth of trenches
Size of stbne
SEEPAGE PI • Numbe
Size - ft. .
Stone size
PIPING: . Si e Type
Bldg. to Tank . `` 51-/O
Tank to Dist. :ox w a 0"
Dist. Box to Field/'-' .
Openings Sealed? (10 No Partial
LOCATION/S'PARATIi_
Foundat.. z to Tank / >-feet
Foundation to Absorption feet
Separation of Pits feet
' Conforms as per. Plot Plan es� No
LOCATION SYSTEM ON PROPERTI'• J_
(circle e
Front - ea - Left Side Right Side
Middle Front - Middle Rear
COMMENTS: •1'1u R A< 5t46 1,, ,c r D&Lv
SYSTEM USE APPROVED: YES NO _
Arrived:
Departed: —14
Building Inspector
11/2Din,
,----7 ' TOWN OF QUEENSBURY 4,
BUILDING & CODE ENFORCEMENT "o
742 Bay Road G
Queensbury NY 12804 V il)
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,.„> G' 3
Location 'ID ir 6/-h^-i- -e.1_-
Date C aD 614 Permit # q6.&O/
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trenc
Depth of trenches
Size of sto5ne
SEEPAGE PI : N b is-
Size - f,,. , ft.
Stone size _
PIPING: Size Type
Bldg. to Tank _
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Se led? Yes No Partial
LOCATION/ PARATIONS:
Foundati to Tank feet
Founds on to Absorption feet
Separ ion of Pits feet
Confo s as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:� /
/�O% /cI)
•
SYSTEM USE APPROVED: YES NO
,)
Arrived:
r
Departed: / 7 35
Building Inspector
1--b ("it. iv 7 it K I c ✓‘ l oivubo 5 --Nrie-t--(c d . 'F ' (gu -- c pc!l/uc.-
FhL S7 v N, 0- iv y 6/Pu.s' rex, r ' /. l 4-0/
\
I
RECENT., vi)01�
SEP 1 7 1999 r r � ,iL 0 tr ,/(�
TOWN OF OU aiNSBURY (.--- 0/-
C1 1 / \ çp
D, ZP A C 4 fiA 6
"I have seen or observed, or believe I saw evidence o ,
all objects suit houses, wells, trees, fences, etc.,
shown on Lcument. I also represent that I have
personally measured the distances set forth on the diagram." �� a ;g JR .� 3i4w. _ a
6,c,i> , q -/6 (--,
SIGNATURE DATE BULDnG _,4
REVIEWED B _I -
DATE . , L .0
ifQf_ -S//FaQ/v 4-41 /V