97-133 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
g\°\\S .L L
This is to certify that work requested to be done as shown by Permit No. 97133
has been completed.
This structure may be used as a SEPTIC ALTERATION
•
Location 14 -CEDA:'RVTOOD R
Owner �'UIT . JAMES & ,NANCY
By Order of Town Board
TAX MM'' MO . 6 8 . -4 -6 TOWN OF QUEE SBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97133
TAX MAP NO. 68. —4-6 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to WHITE, JAMES & NANCY
OWNER of property located at 12 CEDARWOOD DR. 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 CEDARWOOD DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
SANITARY SEWER
3. CONTRACTOR or BUILDER'S Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 April 14 19 99
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(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 14 Day of April 19 97
SIGNED BY B for the Town of Queensbury
uilding and oning Inspector
A Application for SEPTIC DISPOSAL PERIVIIT
Town of Queensbury Permit NoQ 7733
Dept. of Community Development
Building &Codes Office CO
742 Bay Road Fee Paid $J T o
Queensbury, NY 12804 C?e
Location of property for installation: 2 0 T i_xf0 ,/-W-(_ RECEIVEo
Property Owner's Name: '%(M-e( 4L.)A /re. APR 14 1997
Property Own 's Mailing Address: /�- d-eo/V , ��A ,r�/d 6'l/ TOWN Oi ;�=ict i a ilF�Y
4 riti/ii f3itJG UIP COPE
Installer's Name: AU/" - cj ,4 Phone # 9Z' 7�-
Number of bedrooms (if residential): 2 Total daily flow: *?‘--5-1.-)'
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: and, loam, clay, other I depth:
Ground water: at what dep feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: not required; required [rate min. per inch ]
Domestic water supply: `� municipal, - well, othe
If domestic water supply is a WELL, water supply from any septic absorption is feet. .
PROPOSED SYSTEM v
Septic tank: 10°D gallon (minimum size: 1,000 gal.)
Tile field: each trenches feet / Total system Ieng-th:A feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # 2i / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
&lean 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 in reliance upon any material anisrepresentation 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 Haase and all requirements of the Town of
Queensbury Sanitary Sewage Disposal�rdinaa . t�
Signature of responsible person: i ,2,(,�em. Date: / !1 J—9-2
TOM OF QUEENSBURY
BUILDING a CODE ENFORCEMENT 7 i
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C11'le .1_)►'W�
Location )
Date J ) (J� 7Permi t # �r133
SOIL TYPE. Sane oam- lay-
Results of Percol ion Test-
(if applicable) e-Minute/Inch
TYPE OF SYSTEM.
ABSORPTION F ID: To al Length 7
Length of ach trench 50
Depth of trenches /`�
Size of stone 4Z
SEEPAGE PITS: N ber-
Size - ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box .9"6re :-?;-- -
Dist. Box to Field/Pit "40'And
Openings Sealed? ,:.Yr-e-s-Th No Partial
LOCATI Old/SEPARATI '
Foundation to Tank EilTugeet
Foundation to Absorption — feet
Separation of Pits —'�- eet
Conforms as per Plot Plan o
LOCATION OF SYSTEM ON PROPER
(circle one)
Front - Rear - Left Side - Right Side
Middle Fron i ddl
COMMENTS: _------
SYSTEM USE APPROVED: YES MO
Arrived: k2f.to
Depar • 2,
Building in pector
• cmk [ 33 i
et
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JrIC
, RECENFD 1
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"I have'Moor observed,Qr believe I saw eviutomm, in
all objects such es houses,wells,trees,fences,etc., - t __,, APR 14 1997
u
4.
shays*On this deemed I also represent that l have , I... '?"-404--9 TOWN OF "-,•i•;f,g.:ii:-;,;•:.opy 1
meisuridths distances*forth on the diagranef 5r,i/../p/a/.3 .L.. D BUILDING AND CODE
Ilicf- - Tie a-A:- Zorii4L:("?2-
OM
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_ _ -$ U1T-
TOWN OF QUEEN BURY
BUILDING iPT.
REVIEWED BY
DATE / ' • C .
4-A"rtil 0-#1 e,1