1999-675 CERTIFICATE OF COMPLIANCE
.TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 27 19 99
99675
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 asa
234 POTTER RD:
Location
SMITH, . KAREN
Owner
TAX MAP NO.. 90. -2-9 By Order .of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 9 9 6 7 5
TAX MAP NO. 9 0. -2-9
SMITH, KAREN
Permission is hereby granted to
234 POTTER RD.
Owner of property located at
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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
2 3 4 eP)411trRD
QUEENSBURY, NY 12804
• Contractor or Builder's Name:
SANITARY SEWER
Contractor or Builder's Address:
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
Electrical Inspection Agency:
Type of Construction:
. SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
" Proposed Use:
SEPTIC ALTERATION
25 - October 27 2001-
$ PERMIT FEE PAID-THIS PERMIT EXPIRES
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
27 October 1999
Dated at the Town of Queensbury this Day of
SIGNED BY Ly,Q M -t for the Town of Queensbury
Code Enforcemen cer
Fr \,_
Application for SEPTIC DISPOSAL PERMIT
Town.of Queensbury
Dept. of Comoluaity ovelopment Permit No. .q/y—6,75-
Building&" 'Codes office,;
742 Bay Road Fee Paid $ q5—
Queensbur}+,:NY 12804 .
J
Location of property for installation: 23 Li Po 77-t, _ RFCEIVElt
r
Property Owner's Name: eW e,�.7 OCT 2 6 1999
._ _ Property Owner's Mailing Address: 4/t-te A�d�l Cep .
Installer's Name: AN l TW✓ 4/LAR--_ Phone # 7 9; — 7 p-1 7
•
Number of bedrooms (if residential): 2-- Total daily flow: J ° -
(recirlential -compute @ 150 gal./bdrm.) .
Topography: . _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: 0( not required, required [rate min. per inch]
Domestic water supply: munici well, ocher
If domestic water supply is a WELL, water supply from any septic absorption is feet. •
' PROPOSED SYSTEM
Septic tank/O09 gallon•(min;m„m.size: 1,000 gal.)
" Tile field:-each trench /UM feet / Total system length: ' feet
Seepage pit(s): number of / / size each: ID ft. by 8 ft. •
Size of stone to be used: #3 / depth or t rrlmcs 2.-- feet
HOLDING TANK SYSTEM:. (if required)
Number of.tanks: Size of each: gallons
•
' LAla=system and'associated electrical avrk to be impeded by a certified ageocy.1 •
` note that to Section 136-29 of the Code of the Town of
�'`�� `�t,�..�. �'0�°cti'oa' please pursuant �+�r. any or
'; g; granted mwhich is based r on or is granted is reliance upon any metered' fl or me to make a
sfeaal fact:or circumstance known by or on behalf of an applicant;shall be void.
.'..;.I have read the regulations with : •=�il application sad to abide by these and all requirements of the Town of
Queensbuty'Sauitaq Sewage Disposal a r'm5
//
Signature of responsible person: ( i� i✓ Date: /Q 2 6/9 ?
-
�l;3()
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Kate-it SnuLh
Location a:0 -P -/) r Poi
Date "0 .7 Permit # q%(, 7j
SOIL TYPE San -Loam-Clay-
Results o rcola 'on lest-
(if applicable) Ra a-Mi ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: of Length
Length of each tr-32
Depth of wee. •-
Size of stone
SEEPAGE PIT : Nu ber- J
Size - t5 ft. x P ft.
Stone size _ , G
PIPING: Size Type
Bldg. to Tank [� `� 6Lp cd
Tank to Dist. Box
Dist. Box to Fi el /Pi _ It 50f� -7i�
Openings Sealed? 4 ,No Partial
LOCATION/SEPARATION
Foundation to Tank l feet
Foundation to Absorption �� feet
Separation of Pits feet
Conforms as per Plot P1 an Yes No
LOCATION OF SYSTEM ON PROP .
(circle one)
Front - Rear - Left Sid - Right Side
Middle Front - Middle R r
COMMENTS:
•
SYSTEM USE APPROVED: DYES NO
Arrived:
Departed: /0 °-
Building Inspector
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ill 0 v H n shown on this document. I also represent that I have
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