98-163 CEI ,,rIFICATE OF COMPLIANCE
TOWN or QUEENSOURY
WARREN COUNTY . NEW YORK
Date Ap3L 1 23_ 19 _fig
98163
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 39 HRONK DR .
Owner SHAW e HOSUK
TAX MAP NO . 89 . - 2 4 . 12 By Order of Town Board
TOWN OF QUEENSBURY
r
Director of Building 6 Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE S 0 No, 98163
TAX MAP NO . 89 . . 2 - 4 . 12 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to RHaid jjostlw
OWNER of property located at '3 tf 1:klmckNx nn Street, Road or Ave.
in the Town of Clueensbury, To Constructor place a SEPTIC !Lt'.+T MATIDW
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 Oueensbury Building and 'Zoning Ordinance.
1, O WIVE R'S Address is
203 BRONX DR .
QUEENSHURY" , NY 12804
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAN DRELLOS Pik ,BOX 224
GLENS FALLS NY 12801
4, ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction — (Pteasm indicate by X}
SEPTIC
{ I Wood Frame l } Masonry f I Steel f f
7. PLANS and Specifications
Sk$TIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed use
SEPTIC ALTERATION
$ 25P�ERMIT FEE PAID — THIS PERMIT EXPIRES April 21 19 2000
(if a longer period is required an application For an eKtansion must be made to the 13uilding and Zoning inspector of the
town of Oueensbury before the expiration date.)
Dated at the Town of +Queensbury this 26ay of Apr i 1 19 19
SIGNED BY for the Town of iQueensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSA-L PERMIT
F Town of Queensbury Permit No. C C`a I O
L?ept. of & Code ss Development + J 3
Building & Codes Office
742 Bay Road Fee Paid S
Queensburyp NY 12804
Location of property for isasta]lation. �_-. .._,__..._ . . .... ._._
Property Owner's Name: +�T V I S V/�� � �� r... . - ",
Property Owner's Mailing Address: � ! �3rz�,� �- � AP iL 1
/ I"iY V ^` �•` X rl.NJiln 1f / iT�. 14: 1
Installer's Name: .+�+ .4 _._. .,.
Number of bedrooms (if residential): Total daffy flow: y�`�
(residential_ - compute 0 150 gal.lbdrm.)
Topography: r flat* rolling* steep slope % of slope
Soil Nature: sand, loam, clay, other I depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: Y. not required, required [ rate ruin_ per inch ]
Domestic water supply: Z. municipal, wall, other
if domestic water supply is a WELL., water supply from any segdc absorption is feet.
PROPOSED S'YS1704(,wo r,,., �
Septic tank l gallon (minimum size: 1,000 ,gal.)
Tale field: each trench feet / Total system length: feet
Seepage pit(s): number of !i' / size each: & by &
Size of stone to be used: # f delith ors feex
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each.: gallaaas
Alatux sysum and assomated electrical wreck to be inspected by it certified agency.
For psoteciian, please note that pursuant to section 0&29 one the Code of,the Tows of Qoseosbury. =W pesnait or
approval granted wbach is based upon or is wed = nehAnc s Upon tuy m at are� or 6nhue to malos a
machdal fact or cbrcvom ss known by or on babslf of an applicaot� aball be void.
I brave read the tsgutabons with respect to this aappLkabcn and agrss to abide by Neese and all r quirem is of the Town of
QueensbUy Salary gage =jjeporel �/M�-^�`�
Signature of responsible person: ' T
.
TOWN OF QUEENSBURY �
BUILDING 8 CODE ENFORCEMENT !
742 Bay Road
Queensbury NY 12W4
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location C $C
slate B --Z2rq§5permi t # � l�
SOIL TYPE: Sand- Loam-Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Total Length
Length of each trench
Depth of trenches
Size of stone
EEPAGE PITS ` Number-
Size - 4?> _ ft . x ft .
Stone size
PIPING : Size ype
Bldg . to Tank
Tank. to Dist . Box
Dist . Box to Fi el
Openings S,s 1 ed ? Y s� li^o arts a
LOCATION/S
Foundation to T nk feet
Foundation to sorption feet
Separation of its feet
Conforms as p Plot Plan Yes No
LOCATION OF STEM ON PROPERTY :
( circle one)
Front _ Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS :
�SYSTEM USE APPROVED : � 0
Arrived-
DePa :
ding actor
-40W TOMN OF QUEENSBURY l
BUILDING s CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12B04 I
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date Permit # 9
SOIL TYP Sand- Loam- Clay-
Results of Percolation Test-
( if applicable ) Rate- Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Total Le
Length of tr h
Dep tree
Size of sto
SEEPAGE PITS : Number- to
Size - ) ft . x
Stone size
PIPING: Size Type
Bldg . to Tank _ 5Tid3 __
Tank to Dist • Box 6t 'rs [28 �
Dist . Sox to Fi el
openings Sealed ? Yes No artsai
LOCATION/SEPARATIONS :
Foundation to Tank if j&bTj.&f e e t
Foundation to Absorption 7D feet
Separation of Pits -~'�`- feet
Conforms as per Plot Plan [�o
LOCATION OF SYSTEM ON PROP'ERT a-
( circle one
Front ,��� } 9ht Side
Middle Front - � d�[ d ] a Rear
COMMENTS :
SYSTEM USE APPROVED: YEkZ::;; ��
Arrived : 4
Deparited. • 4
ui Ong Inspec r
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r APR 21 1998
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