97-139 -ram - .. _ -. �. -
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 'I 19
. a, L,s. L i ',
(b 0 9 !I 0,...., ..— i43 . •
This is to certify that work requested to be done as shown by Permit No. 971.39
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location 12 PINE ST , `
Owner '+ALLE' . HA FI1 A. ,
By Order of Town Board
TAX. HAP NO. :E29 . _.1.-9 TOWN 0OF1 /BtJR
4>�1c
l
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 97139
TAX MAP NO. 129. —1-9 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to VALLEE , MARIE A.
OWNER of property located at 12 PINE ST. Street, Road or Ave.
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 Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
12 PINE ST. #14
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDER'S Address
JAY SWEET
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( 1 Steel ( )
7. PLANS and Specifications
SEPTPC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES April 15 19 99
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 15 Day of April 19 97
SIGNED BY ,(.ten for the Town of Queensbury
Building and Zoning Inspector
)
"^` Application for SEPTIC DISPOSAL PERMIT O
• STAMP RECEIVED
p O�
Location of properly for installation: C fl I ti_r S r }•J
Owner's Name, e, \ _ _ .V( l 1 1 e... PERMIT NUMB ER
O. 3
alP
Owner's Mailing Address: / Illki e, rri
Cri
Oar
Installer's Name: (< PA-ia'st.vr �•1 hone #: I] (j/
_ . ,..,-)
cd
Number of bedrooms (if residential): •
"Total daily now (residential -compute a1 150 gal. per bedroom): ,—'d It
•Topography: IKI flat r1 Rolling F-1 Steep Slope % of Slope
Soil Nature: k.I Sand n [.Oan 1 t E Clay n Other /DeptIREC P'/ D I
Ground Water: at what depth? feet APR 15 1997
Bedrock or Impervious Material: at what depth? feet TOWN OF CUEENMURY '
BUILDING AND CODE •
Percolation•Test: Not Required I I Required/Rate min. per inch
Domestic Water Supply: • IX Municipal 1----1 Well F1 Other
If domestic water supply is a W1;1..Is water supply from any septic absorption is feet
•
PROPOSED SYSII:M: • •
Septic tank: 7S • gal, (minimum size: l.000 gal.) • - •
,L !s
Tile Field: each trench `TS feet_ / total system length l3 J feet. .
Seepage Pit(s): number of / size each: ft.x Ct.
Size of stone to be used: # • 1 / depth or thickness J U' feet. . . .
BOLDING TANK SYSTEM: (if required)
. • .: Number of tanks: • . Size of each: gal.
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 •
Queensbury, any permit or approval granted which is based upon or is granted iu,reliance a pon
any material misrepresentation or failure to make a material fact or circumstance knorrn by or on
behalf o f an applicant, shall be void. .
1 have read the regulations hill: respect to this application and agree to abide by these and all
requirements o f the Torrn o f Qrrceushury Sanitary Sewage Disposal Ordinance. .
Signature o jresponsib'e person: Date: -/- '7 7
J - ` TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ?t 1/4LG6C
Location /ini6
Date 6 Permit # 577`/”
SOIL TYP . d-Loam-Clay-
i
Results of Per.olation T:.st-
(if applicable) .Rate-M. to/Inch
TYPE OF SYSTEM:
ABSORPTION FIE ! . Total ength
Length of e.c treich i ,
Depth_ : renches
Size of stone
SEEPAGE PITS: Number
Size - ft. x ft.
Stone size
PIPING: ize Type
Bldg. to Tank ' / -�r
Tank to Dist. Box !L� � �
Dist. Box to Field/P. µ_ H
Openings Sealed? icp No Part' 1
LOCATION/SEPARATII .
Foundation to Tank
feet
Foundation to Absorption 7,5 feet
Separation of Pits eet
Conforms as per Plot Plan 11010No'
LOCATION OF SYSTEM ON PROPERT
(circle a -
Front - Rear - Left Side - Right Side
Middle , - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: al NO
Arrived: / I),"A
Departed: 7770
j -- -
Building Inspector
41
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Jire(
Location /Z Ot. �s
Date j(j 7 Permit # Aet/_ .
SOIL TYPE: Sand-Loam-Clay- 7-43
Results of Percol . .n Test-
(if applicable) ' :te-Minute/Inch
TYPE OF SYSTE
ABSORPTION FIELD: . ?btal Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size ft. x • ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet -•
Conforms as per Plot P1 an Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
.Front - Rear .- Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
�C i°77c / 1 A)/. %r-k) .0,O
SYSTEM USE APPROVED: YES NO
Arrived: ? .i
'S
Departed: .9
Building Inspector .
"1 have seen or observed,or beiew I saw evidence al-
all objects such as hove%weds,trim haft Ole
shown on this document I also ripraseet tt I havd
Oft*mural the Maces set fords oe the dram."
TOWN OF QUEENS!):
BUILDING �. D PT. 'ter SITU.1 DAZE
REVIEWED BY -
DATE AIVQ7 PLOT PLAN
TIC SYSTEM
Notices The following statement must be "stamped" on your plot
plan. This sheet of paper may be used for purposes of drawing your
plot plan. After drawing such plot plan, please read the statement
and sign it. . If you choose to use other paper for your plot plan,
the office will stamp those plans for your signature.
FIL E cop ape .
1997,:
i TOWN. OF Ur~•Etitilyi •
l�
,... BUIiDI�IG AND COpE
) 9
\i/
. O-4 , . a
Ili
),-, im\''"' cic
IN
TOWN OF QUEENSBURY dexamination,BUILDINGPARTMENT
Based on our horde
pompliance with our comments shall
not be construed as indicating the
plans and specifications are in full
compliance with the code.
I
---- \-- \k_o