98-244 CLP,'�iI`i+C rl':G C] + COMPLIANCE,
TOWN OF UUEENSBURY
WARREN COUNTY . NEW YORK
Da t e _. May 15 98
98244
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 SYSTEM --
Location LOT 145 HOMESTEAD VILLAGE
Owner IBS SEPTIC
By order of Town Board
TAX MAP NO , 93 . - 2 - 11 . 1 � TOWN OF QUEENSBURY
Director of Building Cade Enforcement
11
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 98244
TAX NAP NO . 93 . — 2 - 11 . 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
IDS SEPTIC
OWNER of property
located at LOT 145 HOMESTEAD VILLAGE Street. Road or Ave.
in the Town of t7ueensburY. To Construct or place a
SEPTIC SYSTEM!
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. $ 'TllMcc MY 5
CALE'DONIA , NY 14423
2. CONTRACTOR or JIU1 LDER'S Name
IDS SEPTIC
34 CONTRACTOR or SUILOER"8 Address
4. ARCHITECT'S No""
5. ARCHITECT'S Address
B. TYPE of Construction — iplease indicate by X) SEPTIC
( } Wood Frarne f l Masonry f ) Steel ( I
7_ PLANS and Speelficstions
SEPTIC SYSTEM[ AS PER PLOT PLAN AND SPECIFICATIONS
Na.
g. Proposed Use
SEPTIC SYSTEM
25 may 11 20+06
$ PERMIT FEE PAID - THIS PERMIT EXPIRES
19
(if a longer Period is required an application for an eateneion must be made to the guild" and Zoning inspector of this
town of Oueansbury before. the expiration � .} a 19
Gated at the Town of Queensbury this
Clay f 19
SiGNEt? BY I for the Town of Oueensbury
Building and Zoni
Applieation for SEPTIC DISPOSAL PERMIT
Town of Queembury
Dept. of Community Development l?errilit No.
Building 8t Codes Office
742 Bay Road Fee Paid
Queensbury, NY 12804 MAY,
Location of property for installation:
d 7Z7q / S
Property owner's Name: / d ^^ � � r� �t v'1 L. �to, �
Property Owner's Mailing Address: L u 7.-T-
Installer's Name: �1_ � ,-/� t C� Phone # Joe / E
Number of bedrooms (if residential): Total daily flow: GJ
(residential - compute (c 150 gal.lbdrm.)
Topography: { K flat, rolling, steep slope % of slope
Soil Nature: d, loam, clay, other 1 depth:
Ground water. at what depth' eet 1 Bedrock or Impervious Material: at what depth? . feet
Percolation test: not required, required [ rate min. per inch ]
Domestic water supply: 2<municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank/J&.0 gallon (minimum size: 1 ,000 gal.)
Tile field: each trench feet 1 Total system length: G d tq feet
Seepage pit(s). number of I size each: ft. by ft.
Size of stone to be used: # I depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each.: gallons
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queenslnuy, any permit or
approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make 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 agree to abide by these and all requirements of the Town of
Queansbury Sanitary Sewage Disposal CNximaannce
Signature of responsible person: Bate: -"C l --'/ ■
TORN OF QUEENSBURYIr
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
I
Name
Location ���
Date — Permit #
I
SOIL TYPE: Sa - Loam- Clay-
Results of Per 1 ation Test-
( if applicable ) Rate-Minute/ nch
TYPE OF SYSTEM:
ABSORPTION FIELD Total Len th
Length of each t ench
Depth of trenches
Size of stone
SEEPAGE PITS : Num er-
Size - ft . ft .
Stone size
PIPING: ize ype
Bldg , to Tank
Tank. to Dist . Box
Dist . Box to Field/Pit
Openings Sealed . Y s o Partia
LOCATION/SEPARATIONS :
Foundation to Tank feet
Foundation to Absorp ion feet
Separation of Pits feet
Conforms as per P1 o Plan No
LOCATION OF SYSTEM PROP R
( circle one )
Front - Rear - Lef Side - ight Side
Middle Front - Mid le Rear
COMMENTS :
i
SYSTEM USE APPRO D: cZZTV� NO
Arrived :
Departed :
u Ing ns r
4C
t— -
� A �
4
I haw seem or observed, or believe I saw evidence of,
aII oble* such as houses, weds, trees, bmces, etc,
sh m to 06 document I also repma tluEt I haw
�—. . sure' distances set fodh on ft diWak"
rlc d
A
$MATURE DATE ,y
1
is
i
TOM OF QUEENSBURY
BUILDING S CODE ENFORCEMENT
742 Bay Road
Queensbury MY 12804
(sts) 761-8256
SEPTIC DISPOSA SYSTEM SPECTION
Name
Location
Date - +� AJ21Permit # LOUL
SOIL S nd- L am-Clay- l
Results of Pe col at-ion Test
( if applicabl ) Rate-Minot Inch
TYPE OF SYS
ABSORPTION FIE D : Total L gth
Length of each Tench
Depth of trench s
Size of stone
SEEPAGE PI jr N nber-
Size - �L_ ft x ft .
Stone size
PIPING :Bldg i yrpe
Tank
to Tank
T
Tank to Dist . Box As
Dist . Sox to Field <. sir
Openings Sealed? es No a� rtial
LOCATION/SEPARATI
Foundation to Ta k feet
Foundation to A sorpti n feet
Separation of P is et
CFF' ront
forms as pe Plot P1 n Yes No
ATION OF S P PER
rcle one }
- Rear - Left Side Right Side
dle Fron - ea
MENTS : I�
Ae, - 5 o i L G��u �F7/ L..<�r
SYSTEM USE APPROVED : YE No
r
Arrived : f . J
Departed :
Building Inspector
rz� qu"mN
�� N
*0 is lull
comovm" *athe coft
FILE COPY
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