1999-637 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 12 .19 99
99637
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 390. DIXON ROAD --
Owner KRISTEL, KANNAN & KELLI
TAX MAP Via, 92 _1- By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
7�_---• .mow .w f..n - - - .-w� .s.��-�..--Tw.. '01�!\--+�. �---• r � .
BUILDING PERMIT
VALUE : :$- 0 TOWN _ O.F QUEENSBURY. No. 99637 _..
TAX MAP NO.. 92.. =1-2.. WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to KRISTEL, KANNAN. & KELLI
OWNER of property located at 3.90 DIXON ROAD 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. OQW�Nv�(ER'S Address is
390 DIXON ROAD
QUEENSBURY, NY 12804 .
2. CONTRACTOR or BUILDER'S Name
KRISTEL, .KANNAN
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please,indicate by XI SEPTIC
I Wood Frame I I Masonry, ( I Steel 1 1
7. PLANS and Specifications
SEPTIC ALTERATION.>AS: PER PLOT. PLAN. SPECIFICATIONS .
No.
8. Proposed.Use
SEPTIC ALTERATION
25 ..,. - October 5 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an e*t.nsion must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
5 October 1999
Dated at the Town of Queensbury;this Day of 19
SIGNED BY . \ bJUI1�� il�+ for the Town of Queensbury
Building and;ZoningInspector
01/.18/1996 10:14 5167454437 TOWN OF QUEENSBURY P PAGE 01
Application for SEPTIC DISPOSAL PERMIT •
r
Tvw�a of Queeasbury : ' • • ' • .
Dept. of Community Development Permit NO.
1 _ ‘7
Buildiog&Codes Office ' . D
742 Bay Road • Fee Paid $ ,
Queensbury. NY 12804 •
Location of property for installation" •� �� , 12+-X6v•
?-611
Property Owner's Name: "KQ!/.thC.ct'i •i'1201 (+ grN S e- '
Property Ownex's mailing Address • 310 +xa1&- FCr P�� D
Installer's Name: 1S , r& Ie'j~ C_p � 'I ru_. Phone# -7A/3-/Z T 0 �` 1999
T�S'';'v vr~c tU ENS�i1RY
•
�UBLpIN ANQ O .
Number of bedrooms (if residential): • •Total daily flow: 3
• • (residential -compute @ 150 gal./bdr;a.) - -
Topography: • flat, '.rolling, steep;slope• % of slope - , "
. Soil.Nature: X sand, loam, .clay, . other t depth:
Ground water: at what depth? feet /•Bedrock or Impervious Material: at what depth? feet
Percolation test: not required, •- regiured•j rate — min.per inch 3
Domestic water supply: j„municipal, : 'we}1,. • 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 Bald: each trench , • feet :I Told system Iength: feet
Seepage pit(s): number of /' • • /: sire each: . $' ft.by, IP,ft.
,
Size of stone to be used: # • '3 •/ 'depth or thickness f feet
HOLDING TANIC SYSTEM:' (if required).'. • ' •
Number of tanks: • ' •$ize.of each; gallons
(Alarm aystem mad associated eIectneal woxic,td be mapmetrd by a certified agncy.
v '
For your pmtecton, please dote that putauare to Se tio.4.136-2P of. •Codo'of the Town of Queembury.any parrot or
approval granted which is bated upon or le e .hi red 4:?s ac•kayaaaatexisi uaaxopseaautatioa car More to neks a
material fact or circumstance;Imoawn by or on bake of ai applicai t4'shall.be void.
I have read the regulatioae with reaped to ilti;)eppUoa1 o arid:agree Lo abide by these anti all re uire4vcts of the Town of
Queermbury Sanitary Sewage pitpoael . ' 1
• —
Signature of responsible person: �Yti?9l�-� l�' �-.3.-, Date: i I/
S I
61P12)
Q1
�✓� `'"� TOWN 0 QUEENSBURY
ItRupt BUILDING & CODE ENFORCEMENT
d_ 742- Bay Road-
f Queensbury NY 12804
��'_ r (518) 61-825
v�SEPTIC DISPOSAL SYSTEM INSPECTION
• Name VISL-
Location 390
Date Iv ( 0 Permit # 99—«
SOIL TYP : an L m-Clay-
Results - rcolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Nu ser-
Size - Q f . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. rox
Dist. Box to Feld/Pit
Openings Seale.? Yes No Partial
LOCATION/SEPA' .TIONS:
Foundation to Tank feet
Foundation ti Absorption feet
Separation o Pits et
Conforms as per Plot Plan _ Ye
LOCATION 0' SYSTEM ON PROP
(circle on
Front ear e Side - Right Side
Middl - Middle Rear
COMMENTS:
51 cea /Th_
� 5_, Co
SYSTEM USE APPROVE - YE NO
Arriv :
Dep ted
Building n pector
TOW OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location -3)0to Vnin)
Date — Permit #
SOIL TYPE: an.-.oa -►lay-
Results of Percolat'on Test-
(if applicable) Rat--Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: 'Fatal Length
Length of each tren h
Depth of trenches
Size of stone
SEEPAGE PITS: Numbe -
Size - ft. x IC ft.
Stone size 1L7 ,
PIPING: I Size Type
Bldg. to Tank - *LC)
Tank to gist. Box- __IA!'
D+st.—B -- 4 Pit -- —Openings Sealed? Ye. No Partial
LOCATION/SEPARATIO S:
Foundation to Tank B ( eet
Foundation to Absorption 7i- feet
Separation of Pits feet
Conforms as per Plot Plan ;14i7IDNo
LOCATION OF SYSTEM ON PROPER .
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
•
SYSTEM USE APPROVED: ES
Arrived: • 7
Depart . "f .
•c.
Bui mg I ec -or
•
01/18/1996 10:14 5187454437 TOWN OF QUEENSBURY P PAGE 02
•
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• T.
REV PWEo. N it / A 4 3' • 2 CT 0 4 is:.- • • . .. . • ..•
—��
•
Jc.an
rwr ?,. . . u • • • . .
t •
''I,hive see '.•ir observed, believe I saw •vidence of.' r
• • all-,lje'ct ', u.ch:as hous, , wells, trees, -nces, etc.,
: .., . . ....
. . . .
s �.wrz o 'thiS'.d'ocume I also repr•:ent that
..
Aor,
....
P isan- �y'measured the di e
/ .nce- set forth o e diagra All, alpo,
;SIGNATURE
= D TE