98-311 CERTIFICATE OF COMPLIANCES
TOWN OF QUEENSBURY
WARREN COMITY . NEW YORK
Da to Jline 5 19 __98
This Is to certify that work requested to be done as shown by Permit No . 98311
has been completed ,
This structure may be used as a SEPTIC ALTERATION
Location 7 HEINRICK ST .
Owner KOKOSA , ANN
By Order of Town Board
.� TA3C MAP NO . 9 @ . - 4 - 1 13 �OWN or (tt}E y �� _
Director of Building Cade Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF 'QUEENSBURY No.
TAX NAP NO . 90 . — 4 - 113 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to KC3KOSA ANN
Street, Road or Ave.
OWNER of property located at
7 HEINRICK ST .
in the Town of Queensbury. To Construct or place s
SEPT
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 Queertsbury Building and Zoning Ordinance.
IIIII
rCOHIT"A
ress isICK ST .
URYr NY 12804
R or GUI t.t7 Z Name
DAVIDR or SUILOER'S Address
4. ARCHITECTS Name
5, ARCHITECTS Address
G. TYPE of Construction — (pieese indicate by x) SEPTIC
I } MVood Frame C I Masonry l I Steal I }
r7P:LANIS and Specif icationsT,TC ALTERATION AS PER PLOT PLAN SPECIFICATIONSProposed use
SEPTIC ALTERATION
June 4 2000
25 t9
y PERMIT FEE PAID — THIS PERMIT EXPIRES
Itf a Ior4gw period is required da shea siKpM� dree jxtgnslI nwo be rjwKw to the 8uming and Zoning inspector of the
town at OwenaburY
4 June 19
Dated at the Town of Queensbury this Dsy of — ---tg
for the Town of QueensbuTV
SIGNED BY euildtrg *ad 2onine
• = Application for SEPTIC DISPOSAL, PERMIT
Town of Qunensbury Permit No '`� ��
Dept,.. of Community Development
Building & Codes Office 00
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: 7 4N G
Property owner's Name: f f / ,Ii p I 'C3 q
Property owner's Mailing Address:
Installer's Name: f/r/0 Phone # O;L -LZ -.2.
Number of bedrooms (if residential): Total daily flow:
(residential - cotnptitjLo I %.39Q&rn,)
Topography: �' flat, rv3llag, sreep dove 7a of slope
Soil Nature: sand, loam, clay, otb.= I depth:
Ground water: at what death?O fl ' feet / Bedrock or lrrme^rcus Material: at what depth? _ feet
Percoiarion test: �ot required, required [ Tara min, per inch. ]
Domestic water supply: 'municipal, well, ccm�
If domestic water supply is a 'WFL.L, water supply uom any se c absorption is feet,
PROPOSED SYST."M
Septic Mn 1 /'CA&40/ gallon (mix t= size: 1 ,000 gal_) {y£
Tile field: each, trench feet I 'Total system 'yw7gtha feet
Seepage plt(s): number of r / size e:ciZ: _ fr. by FG
Size of stone to be used: # / depth or dtdc"r".s� .2 ''Y4-/� feet
HOLDIING TANK SYSTEM: (if required)
Number of raxiks: Size of ea bL-- gallons
AL== system and associated elecbtioal vwrk to be io rpec`ed br a certified agency.
For your protection. please Dote that pvrauant to Section 13Er29 of tlae Ccda c f :±:o Town of Quaenabury, any permit or
approval granted wrbicle is based upon or is granted ice reliance up+ou asp manter:1zi ;nisreprasenbaiou or failure to make a
maseriad fact or circurn_atance ]mown by or on behalf of an applicant. . , n be 1pciaL
i have reed the rogutations with respect to this appticataaa and agree to abide br deae and an requirerns=tsof the Town, of
<?uecnsbury Sanitary Sewage Disposal
Signature of responsible person: Dare:
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road %fyrV\
Queensbury NY I2804
(518) 761-82M
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date Permit #
SOIL Toam- Cl ay-
Results of Percolation Test-
( if applic4ble ) Rate-Minute/ Inch
TYPE OF SY :
ABSORPTION F LD : Total Length
Length of each'\t
Depth of tren
Size of stone
SEEPAGE PITS : umber
Size - ft . x ft ,
Stone size
PIPING : " "' Size Type
Bldgw to ank 11 �j
Tank to Dist . BoxL4ti
Dist . Box to Fiel +x
Openings Sealed ? artTa
LOCATION/SEPARATIONS :
Foundation to Tank eet
Foundation to Absorptionrf
eet
Separation of Pits eet
Conforms as per Plof Plan No
LOCATION OF SYSTEM ON PROPERTY:
( circle one )
Fro Left Side - Right Side
'x6 dcera r �" e F �_- � ""n dl a Rear
--- r r
COMMENTS :
SYSTEM USE APPROVED:.
Arrived : =Z
Depart
ui*FB I d-fngf Anspector
i E
I
i
90_ -112
JUN 03 �
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i
F -� �•
yC..y �U1 0 All
Aly
Ze/
�M WFMWMM 144rr ► .
IN
aersendV i � � an � iiirs
*M
SHaVATM DATE
Produced by the Town of Queensbury, NY, Building Department
06/03/1998