98-145 f
4
CI'RTIFICATE OF' COMPLIANCE,
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Date April 13 19 98
98145
This is to certify that work requested to be done as shown by Permit No .
has been completed .
This structure may be used as a SEPTIC ALTERATION
Location 12 BUENA VISTA AVE .
Owner BAROUDZ , ELIZABETH/JOYCE By Order of Town Board
TAX KAP NO . 79 . - 1 - 11 TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ TOWN OF QUEENSBUR'Y'' N� 98145
TAX MAP NO . 79 . -- 1 - 11 WARREN COUNTY* NEW YORK
PERMISSION is hereby granted to BAROUDI r ELIZABETH/JOYCE
OWNER of property located at 12 BUENA VISTA AVE . Street, Road or Ave.
in the Town of Oueensbury.
To Construct or plaoe 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.
t. 0WNER"S Address is
CARROLL 12 BUENA VISTA AVE .
¢UEENSEURYr NY 12804
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. iO3 fA ��8U1LflERS Address
OAA'YY
4. ARCHITECTS Name
6. ARCHITECT'S Address
6. TYPE of Construction — (Ptease indicate by X) ,SEPTIC
i 1 Mond II ( I Masonry I I Steel t l
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
No.
8. Proposed Use
SEPTIC ALTERATION
25 April 13 2000
S PERMIT FEE PAID - THIS PERMIT EXPIRES , 19
III to""longer
r period is raq "d a the liO tr On f date.)
& jxtensian must he made to the Bul6ding and Zoning inspector of the
ury
qKp
13 April 19
Dated at the Town of Queensbury this , ay of
SIGNED BY 19
for the Town of Queensbury
ild+rq +tMd Z nirtg 1 rtaP+adr
Application for SEPTIC DISPOSA.L PERMIT
Towrt of Queensbury Permit No. —1 C
Dept. of Community Development
Building & Codes Office Cm p
742 Bay Road Fee Paid $,; J
Queensbury, N"Y 12804
Location of property for installation: �/ tt n s,f/, s iL r
Property Owner's Name:
Property Owner's Mailing Address: �/ f "� - ` ' `'` "'S �""�
Installer' s Name: =24_ .: 1 � „� Phone # 3 ''J
-75
Number of bedrooms (if residential): � Total daily flow: _ 5
(residential - cornpu
Topography: / flat, rolling, steep slope `i'o of slope -
APR 18 IM
Soil Nature: /< sand, loam, clay, other I depth:
TOWN
Ground water: at what depth:' feet I Bedrock or Impervious Mate_riat4 a1kd*W-`' -qleet
Percolation test: ,�,� not required, required [ rate min. per inch ]
Domestic water supply: /'� municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
,ems r
Septic tank:,!''! gallon (truni.mum size: 1 ,000 gal .)
Tile field: each trench J,�17 feet I Total system Izngath: o--d feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone ro be used: # noLW depth or thickness ZJ feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each gallons
-------------------------
A]ann system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-1_9 of the Code of the Town of Queeasbusy, any permit or
approval granted which is based upon or is granted in reliance upon any material misrepresexvtation or failure to cnaka 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 ages to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal ice_
SFanarure of responsible person: Date:
A00
fp TOE OF Q�IEENSSIIRY
B1f��` CODE Et1FORCT
742 Bay N oad�4
QueensburY
(518) 761-8256
SEPTIC 'DISPOSAL SYSTEM INSPECTION
dame X
c
Location
it #�
Date "
SOIL TYPE: S nd- oam-C Y-
is of erco'l ati on est-
pp
Resul
( if atslica 1e) Rate-Mi ute/inch.
TYPE OF SY
ABSORPTION IELD : Total Le�.st ----
Length of a ch tren h
Depth of tr ches
Size of ston Humber-
SEEPAGE PITS: ft , x f t .
Size ~ ��—
Stone size Size e
PIPING: ��
Bldg . to Tank
Tank to Dist . Box
Dist . Sox to Sealed*?
LOCAT Field
d es o arti a
Openings feet
Found ONESEPARAT feet
Foundation to Ta k do eet
Foundation to Pb is a No
et
Separation of er PI t Plan
Conforms as P on PROP
LOCATION OF SY5
( circle t Side - Ri t Side
Front - an
r F- M ddla Rear
Middlet
CO1q+4ENTSky
=
SYSTEM USE APPROVED
ES no
Arrived:
Departed : 7" /Afi"
Sui d1ng nspector
TOWN OF QOEENSBURY
BUILDING A CODE ENFORCEMENT
742 'Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location % ? L
Date �-]_� ' Permit # �' I
SOIL TY - lay- 13
`r
Results of Perc °Minute/Inch
lation Test�
( if applicableble)) Rate
TYPE OF SYSTEM:
ABSORPTION FIELD , e chal gth
Length of e h
Depth of tre hes
Size of stone e -
SEEPAGE PITS .
Size - ___--- ft . �— �— ft .
Stone size __ Size --- e
PIPING:
Bldg . to 'Tank -------
Tank. to Dist . Box
Dist . Box to Fiel /Pit No
artia
openings Sealed? Yes
LOCATION/SEPARATIONS : feet
Foundation to Wank ti on �� feet
Foundation to Absorp --- -- feet
Separation of Pits ----- es No
Conforms as per PI a� PROPERTY :
I Bn
LOCATION OF SYSTEM
( circle Rear _ Left Side - Right Side
Front - Middle Rear
Middle Front
COMMENTS
SYSTEM
USE APPROVED - YES Nb
Arrived: Ems'
Depa
ul c r
TOWN OF WEENSBURY
LDING A CODE ENFORCEMENT
742 Say Road
:IC
ernsbury NY 12804
(S18) 761-8256
DISPOSAL SYSTEM INSPECTION
N "-�
Location
Date permit #
SOIL TYPE : Sand- Loam- clay-
Results of Percolation Test-
( if applicable) Rate- inute/ Inch
TYPE OF SYSTEM:
ABSORPTION 'FIELD : To al Length
Length of each trenc _
Depth of trenches
Size of stone '
SEEPAGE PITS : umbe -
Size - ft . x � ft .
Stone siz ixe yPe
PIPING:
Bldg . to Tank
Tank to Dist . BOX
Dist . Box to Field/Pit
Openings Sealed ? Yes No artia
LOCATION/SEPARATIONS : feet
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits
"Tonforms as per OCATION OF SYSTEM o p ON
lan
LPROPERTY :
s No
( circle one ) i ht Side
Front "I ilear�1 Rig
-Sf+ ;dde
Middle Front COMMENTS :
�ti�.t,.� � 5��— 'mac ►� SAS
SYSTEM USE APPROVED : YES 0
Arrived.
Depa - .
r... r
di
W
APR 13
cy
h &V"'� FmREVIEWED BY �
DATE
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