98-209 CL+ RTIFIC. rrE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Date May 4 19 9.-$
98209
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 -4
Location 160 SHERNLAN ISLAND RIB .
Owner RI ST . SANDRA
By Order of Town Board
TAX MAP NOo 149 . - 1 - 1 . 2 TOWN OF {QUEENSBURY
rt
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 98209
TAX MAP NO . 149 . - 1 - 1 . 2WARREN COUNTY. NEW YORK
PERMISSION is hereby granted to RISTs SANDRA
OWNER of property located at 150 SHERMAN ISLAND Rn . Street. Road or Ave.
in the Town of Queensbury. To Construct or place a _ SEPTIC &L=AT10N
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.
t. OWNERS Address is
SHERMAN ISLAND RD .
QUEENSRURYr NY 12804
2. CONTRACTOR or BUILDER'S Name
TUCKER , PLINEY
3. CONTRACTOR or BUii.DEWS Address
41 DIVISION ROAD
QUEENSEURYr NY 12804
4. ARCHITECT'S fVame
S. ARCHITECT'S Address
S. TYPE of construction — fPNsase indicate by X) SEPTIC
I I wood Frame i I Masonry I I Steel I I
7. PLANS and Speclfi4pations
SEF7IC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
f). Proposed Use
SEPTIC ALTERATION
25 May 4 2000
S PERMIT FEE PAID — THIS PERMIT EXPIRES 1$
(If a longer period is required an application for as exterWOn must be meld to the Building and Zoning inspector of the
town of Queeosbury before the expiration date.)
4 May 19
Dated at the Town of Gueensbury this Day of 19
SIGNED BY 4 for the Town of Gueensbury
ui Ma and zJANv I n000ctor
JL J.k� J�jj,�3l lN.LVAJL. 1
Tows= of Quiecasbury Permit No.
Dept_ of Community Developm=at
$uildl=z & Codes Office
742 Bay Roo Fee Paid S
Qt. nsbury. NY 12804
L,ocation of property for insm ation: Ptb ad
Property Owner's Name:
Property Owner's wiling Address:
Installer's Natne: � r'� r A 4? �Z --' .e.-- Phone ig /� �J� �jl
Number of bedrooms (if residendal): � Total daily flow:
(resi.denri-A; - compute a fl 4Ibd=irt: =�
Tomography: :3a:, tcalling, steep slope of slope
MAY 19%
Sou itiature» loam, clay, o = I depth: C d, ^v
.Ground water: at w Ar depth? feet I Bedrock or T=pe^acts i+TAcerial: at
Percolation test: act required, required [ ra= =in. per inch �
Domestic water supply: municipal, well, c•� .�
If dcmesdc water supviy is a �Vv=, wat~._ suvuly =ors. any 5='C absorption is fret.
PROP()SED SYSTEM
sevtic ta.a gallon (rrr1nIrr7vT= S=* e: I ,GC4 gal.)
Tile field: each trench � �' feet I TO"-I syrstetn
Seep
ace pit(s): numbe_." of / size each: fr. by f
Size of stone to be used: r / demoth or th cl� feet
HOLDDiG TAYK SYSTFW: (if required)
Number of tnn Size of each za.71cras
Aia= synam and associated electrical. Rork to bO L=r?*=t* F b► m ear`dEed ageoc-,f.
Fur your proreco�on pleaaa note tb&t pursuant to _ cb 136-29 of t )a Cale of :Se Town of Qaecusbmy, a=,v perna's or
a�+rarcoval xrs ad wtuch is based upon or is sraated i= rein?nca u9oa znrp . xArepzeaar�on Cr fmaura to ms3cs a
==JLL&--.a]. fact or ]crown by or on behaiif of m act Ucasx. Shan ba 4aic_..
I ia':e read aLff resulsaerus with respect. to tins applicat cn and a .s to abide b.- cen and stl reyu iramerits of d$o Town of
C�}e aybury suaituy Sewage Disposal
SiY a_L:re of responsible pierso ate: .tea
TOM OF QUEENSBURY
BUILDING A CODE EN'FORCO"T
742 Bay Road
Queensbury NY 12$04
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name .
Location �-
Date ' +� Permit # ��
SOIL TYPE : Sand Loam-Clay-
Results of Percolation Test-
( if applicable ) Rate- Minute/Inch
TYPE OF SYSTEM:
ABSORPTION Fje
al Ler�th
Length of ea V o V
Depth of tre
Size of ston _
SEEPAGE PITSr-
Size - ft .
Stone size
PIPING : Zze YP
Bldg . to Tan } ,AJ Qi -
Tank to DistDist . Box toOpenings SeaY s o ar `
LOCATION/SEPARATI
Foundation to Tank feat
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPER
one )
ti
- Rear - Left Side - Right Sidedl e Front - Middle Rear
COMMENTS :
SYSTEM USE APPROVED : YES NO
Arrived : ` '
Departed :
__.. Building�lnspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(519) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Locati onv -
Date Permi t
SOIL TYPE: Sand- Loam-Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEW
ABSORPTION FIQLD: Tota Length
Length of each tree _
Depth of trenc s
Size of stone
SEEPAGE PITS : N er-
Size - f x ft .
Stone size
PIPING: Size ype
Bldg . to Tank
Tank to Dist . Box
Dist . Sox to Field/Pit
Openings Sealed ? Yes Vo artia
LOCATION/SEPARATIONS : feet
Foundation to Tank
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rehr - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS :
SYSTEM USE APPROVED : YES NO
Arrived:
Departed : Z O
Bui ding nspector
two
VIP
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