98-362 CERTIFICNrE 01P COMPLI., NCL44
TOWN OF QUEENSBURY
WARREN CC7UFl1'Y , NEW Y+C3RkG
l
Date June 25 19 98
• {D c � - i 98362
This is t � fy that work requested to be done as shown by Permit No .
has been completed .
This structure may be used as a SEPTIC ALTERATION
Location 11 BONNER DR .
Owner BUCZEK O CARL & LINDA
By Order of Town Board
TAX MAP NO . 751 - 1 - 16 TOWN OF QUEE/NSBURY
Director of Building & Cade Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEEN58URY No. 98362
TAX MAP NO . 75 . — 1 - 16 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BUCZEK r CARL & LINDA
OWNER of property located at 11 BONNER DR , Street, Road or Ave.
in the Town of Oueensbury. To Construct at 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 Oueensbury Building and Zoning Ordinance.
Y_ OWNER'S Address is
11 BONNER DR .
QUEENSBURYr NY 12804
2. CONTRACTOR or BUILDERS No""
SANITARY SEWER
3. CONTRACTOR or SUILOER'S Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
4. ARCHITECT'S Name
S. ARCHITECT'S Address
B. TYPE of cormlruction — (Please indicate by XI SEPTIC
I I V*bod Frame I I Masonry l l Steel ( I
7, PLANS and Specifications
SEPTA ALTERATION AS PER PLOT PLAN SPECIFICATIONS
S. Proposed Use
SEPTIC ALTERATION
25 ,Tune 24 2000
S PERMIT FEE PAID — THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension "um be made to the Building and Zoning inipector of the
town of Oueensbury before the expiration date.1
24 June 1998
Dated at the "Gown of Oueensbury this Day of 19
SIGNED BY R—.[hh for the Town of Oueenstwry
Building end Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Qu"nsbury
Dept of Community DevelopmentPermit No. _ _.....
2 Bay
Bayy 8c Codes office 74
742 'Road Fee Paid
Queensbury, IVY 12804
Location of property for installation:
JUN 2 4 IM
Property Owner's Name: + IZ t/ 3 Ca e. Z ,004 AI e „
Property Owner's Mailing Address:: I I B a /V/%j e /L.
Installer's Name: A re- A,%O s' f45 t J C.& Phone # 79 9 -7
Number of bedrooms (if residential): 3 Total daily flow: 14 a
(residential - compute 0 156 gal./bdrm..)
Topography flat, mpg, steep slope of slope
Soil Nature: sand, loam, clay, other / depth:
Ground wafter: at what 4epth2 feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: VOOO not required, required ( rate min. per inch ]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank 00Z� gallon (minimum size: 1,000 gal.)
Tile Held: each trench S�D feet / Total system iangth.: i o 3 feet
Seepage pi*): number of / size each: ft. by ft
Size of stone to be used: # / depth or tbir c / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each.: gallons
.Alx m system and associated eiactrirml wa>dc to be iwpe by a cattisel agency.
For your protections pleeze note that puxaoaat to Section 06-29 of the Coda of the Town of Qpe=nsbury, my permit or
approval granted which is based upon or w granted is relumce upoxx any material WISMS 666Ct2d0n Or hill a to malts a
material fact or circumatonce lmowa by or on bahalf of as applicant, shall be void.
I have read the regulations with respect to,this apphcation and agree to aboi la by these and all requirements of the Town of
Qwenabuz7l S=ftaX7 SOWN86
Signature of responsible person. ' Date! ,�"'-
TOM OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury MY 1280+4
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location .11f f
Date (7 , - - ,Permit # E.
v
SOIL TM'PE(:"'�p�i^-foam-CZ ay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ Inch.
TYPE OF SYSTEK*w
ABSORPTION FIELD,; T-fi al Length
Length of each . trenc`tr-- --'' � _
Depth of trenches
Size of sto e 7
SEEPAGE PIS : Number-
Size - ft . x ft .
Stone size
PIPING : Size Type
Bldg . to Tank ^�
Tank to Dist . Box t-l"
Dist . Box to Field/Pit EQ�F
Openings Sealed? Wara
LOCATION/SEPARATIONS :
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan �T
LOCATION OF SYSTEM ON PROPE..,� ' �
( circle one )
Front - Rear - Left Side - Right Side
Middle Front y b^d- a " W"
COMMENTS :.
SYSTEM USE APPROVED :
Arrived:
Oepa .
uil ing sector
A.31;
I d
I d
NAAOJL
lz
ow r- �a (Sa
eL,
LA
area
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