1999-700 CERTIFICATE OF COMPLIAN E
.TOWN .OF QUEENSBURY.
WARREN COUNTY, NEW -YORK
Oa .e November '10 .1.9• 99
I • .9.9700
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
15 GREENWAY .DR', • --
Location
wne DAVIES, DAVID, JR &
Or
TAX 'MAP"NO: 71.. -1°.-13 " 'By. Order of Town Board
TOWN OF QU ENSBURY
Director of, Building & Code Enforcement
1 1
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
VALUE $ 0 Building Permit No. 99700
TAX MAP NO. 71 . -1-13
DAVIES, DAVID, JR. &
Permission is hereby granted to
Owner of property located at 15 GREENWAY DR.
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.
Owner's Address:
BLAIR 15 GREENWAY DR.
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 - November 9 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.)
9 November 1999
Dated at the Town of Queensbury this Day of
SIGNE for the Town.of Queensbury
Code Enforcement Officer
1 Application for SEPTIC DISPOSAL PERMIT
., .
•
. ,
j •
Town of Queezisbury
i .
Dept. of Community Develop Permit No
ment •
' •. , Building 84 Codes Office'
742 Bay Road • ' Fee Paid $
Queensbury, NY 12804
Location of property for installation: /6 6re e"ci.kohty 2:024,0e_
••.. Property Owner's Name: 'BC Prl a-- D A--kii g S' RECEfivpD
NOV 0 9 1999
• Property Own 's Mailing Address: 11Pf iti-t
--
Installer's Name: - N Vrfn jibt)-44--- Phone #
, . -•Number•of bedrooms (if residential): 3 Total daily flow: Yg °
(residentinl -compute @ 150 gal./bdrm.) .
. ..,
Topography: 4 flat, _rolling, _ steep slope % of slope
, '. . • Soil Nature: ri„.sand, loam, clay, other/depth: _
. Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: 2Lnot required, required [rate nun. per inch]
.• ./ .
Doniestic water supply: municipal, well, other
••r
If domestic water supply is a WELL, water supply from any septic absorption is . feet.O .. •
PROPOSED SYSTEM /
• i
.Septic tank 1 e°° gallon.(Hnfrm;ITYL size: 1,000 gal.)
-)
L ill
' Tile fleld:''each trench .6"° feet / Total system length: 3 ' feet r/244-7-0(- i'b- - i
0 0 Seepage pit(s): number of / size each:
P/k
ft. by ft. • •
, . - •
Size of stone to be used: # / depth or thinicnpeis feet
•
• .
HOLDING TANK'SYSTEM: (if required)
. Number of tanks: 0 Size of each: gallons
• _... .
(Alai list and associated electrical Rork to be inspected by a certified ageocy.) •
•.2,OtiFor;;y9u4Ai:ection. please ate that pursuant to Section 136-29 of the Code of the Town of Qneensbury, any permit or
I:140F,'4.i..r .granted which is based,upon or is'panted in reliance upon any material misrepresentation Cr failure to make a
naieaa.ficeor dicuinstice knOWS1 by or on behalf of an applicant;shall be void.
?:41' ',0;•- .:. . • •
I have read the regulations with respect - ..' application — .:. -- to abide by these and all requirements of the Town of
• Queenabury•Simibuy Sewage •. •• •1 • •.• ,•
.
r i
Signature of responsible person: 1 ' (.41119 Date:
/2
TOWN OF QUEENSBURY ')
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location 1 cJ 6....Yto9,, 0 �Y
Date 11 — TIC/permit # !— Ce
SOIL TYPE: and-Loam-Clay-
Results of colat.• Test-
(if applicable) R. e-Mi ute/Inch_
TYPE OF SYSTEM:
ABSORPTION FIE a: Total ength/oHX)
Length of each trench Jam .
Depth .6f e •
Size of stone lit,yr“---c(LA /L
SEEPAGE PITS Number-
Size - ft. x ft.
Stone size .�
PIPING: Size Type
Bldg. to rank 61CW-/ue
Tank to st. Box 4-`" go/L 35—
Dist. B. to Field/Pit u
Openin Sealed? No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption ±feet
Separation of Pits leet
Conforms as per Plot Plan Y, No
LOCATION OF SYSTEM ON PROPERTY:
(circle o
Front - ea - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: -AA-77m) T
Building Inspector
6
-- ' A i 11 "I have seen or observed, or believe I saw evidence of,
<'` P.
U all objects such as houses, wells, trees, fences, etc.,
shown on thi ocument. I also represent that I have
``°`5 personal me tired the distances set forth on the diagram."
i::---: Z-7----';',,:,-; ;4N„,,_.. _...
is- NATURE DATE
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