1999-724 •
Certificate of Compliance
Town of.Queensbury
. Warren County,New York
Novenlbei. 29 99
Date
99724
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
3' BOSS RD.
Location
Owner ROSS, SHANE & CYNTHIA
TAX MAP NO. 142 < -a-21
By Order Town Board
TO,W O QUEENSBBY
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. 99724
TAX MAP NO. 142 . -1-21
ROSS, SHANE & CYNTHIA
Permission is hereby granted to
Owner of property located at 3 BOSS RD.
•
in the Town of SEPTIC ALTERATION
Queensbury,to construct or place a
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:
3 BOSS RD.
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 29. 2001. _
$ PERMIT rEE 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.)
29 November 1999
\ . Dated at the •wn o r Queensbury this Day of
SIGNED BY j' for the Town of Queensbury
•i- Enforce ••-it Officer
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury F F�!V E
Dept. of Community Development '-� Permit No. 99-70R,
Building &Codes Office NOV 2 3 1999
742 Bay Road Fee Paid $
Queensbury, NY 12804 TOWN OF QU LASBURY
BU@LDiNG AND CODE
Location of property for installation: 3 I�' c t5s
Property Owner's Name: i--I,QNE- L • Oss
Property Owner's Mailing Address: -3 6055 "Rio . (2).5 E,,,s3 op , AU 1
Installer's Name: SA r t'rA' Sze--tom Phone # 752- 3//9
Number of bedrooms (if residential): .3 Total cjaily flow: a7J
(residential -compute'@ 150 gal./bdrrn.)
Topo phy: XT flat, rolling, X steep slope % of slope
Soil Nature: X sand, loam, clay, other /depth:
Ground water: at what depth? SO feet / Bedrock or Impervious Material: at what depth? 5.) feet
Percolation test: X not required, required [rate min. per inch]
Domestic water supply: X municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank: / 11. gallon (minimum size: 1,000 g�,1.) Zxisbi j
Tile field: each trench feet _ / Total system length: feet
Seepage pit(s): number of 2- / size each: . g ft.by a 4 ft. o? /6974/'e X/d)
4G
t.
Size of stone to be used: # / 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.
J
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or
approval granted which is based upon or is granted is reliance upon any material misrepresentation or failure to make a
material fact or circumstance kmwn by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this app'cation and to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage DispoOa /
Signature of responsible perso Date: j/ Z3/ �1
ViArA-e' 121)7V. 4 iti
• TOWN OF QUEENSBURY -
BUILDING & CODE ENFORCEMENT
742. Bay Road •
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name5:-.W94/ 1-Dire(-11da)
Locat' �i��J
Dat ifi ceg ermit # 63449
/7�
SOIL TYPE: and Loam-Clay-
Results of Percolation Test-
(if applicable) R te-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length
Length of each tre ch
De* of trenches
Size of stone
SEEPAGE PITS: Number- 'z—
S i z e\- _ � f t.,4x A) ft.
Stoned size _ .�2-- 6�� .2 'SF,.k_
PIPING: Yi. Size Type
Bldg. )to Tank i /-:-K«4
Tank to Dist. Bo,xx iii„ sDe
Dist. Box to Field/Pit. et' dnk'
Open i ngs�, Seal e0 /Yes: No Partial
LOCATIONSEPAF ITI ONS
Foundation to Tank , feet
Foundati on tQ Absorp ti on/Z feet
Separation Pits __feet
Conforms as- der Plot Plan — .s .No
LOCATION 0 STEM ON PROPERTY:
(circle o 'e)
Front - 'Bear -.. .eft Side - Right Side
Middle Ffont - Middle Rear
COMMENT :
SYSTEM USE APPROVED: igt!" NO
Arrived: GI Sr
Departed:
Building nspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name g,..,
Location 3 9o_ve, c
Date // 5 SS Permit # 95-727
SOIL TYPE: _,
of Percol� tion Test-
(if apRrlicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPjION FIELD: Total Length
Length, of each trench
Depth 'of trenches
Size oaf stone l
SEEPAGE PITS: Numb"r-
Size -\, 6, ft. : ft.02,454c
Stone s' ze _
PIPING: Size Type
Bldg. to Tank
Tank to D'st. Box
Dist. Box Ito Fiel /Pit
Openings Saled? Yes No Partial
LOCATION/SE?ARA ONS:
Foundation tp T nk feet
Foundation tk A sorption feet
Separation of\ its feet
Conforms as p '., Plot Plan Yes No
LOCATION OF . STEM ON PROPERTY:
(circle one)
Front - Rea - L-ft Side - Right Side
Middle Fron - Middle Rear
COMMENTS:
•
SYSTEM USE APPROVED: YES iel
Arrived: P:36
Departed:
3
Building I pector
BGSS 7 b.
3o'
, y,STIN6-
/G0b 6AL.
TANK
J- ooSE
olv
SLAB
-DEC K
(;) GX►o
-DRY W F_4L 3
2 e t 2 S Toc1E
70��F 73A�k
Ti•WN OF QUEENSBURY
B ILDING & CODE DEPT.
R:VIEWED BY /
D TE 3 S
.S RA Ross
SCALE 1" - 2o'
O U'DSUN .- • 3 Boss �'�