98-450 CLI- TI FICA ,rE Olil COMPLIANCE
TOWN Or- QUEENS13URY
WARREN COUNTY , NEW YORK
Oa to 7111 v 7,3 19
This is to certify that work requested to be done as shown by Permit No . 98450
has been completed .
This structure may be used as a SEPTIC ALTERATION
Locat4 "' SHERMAN AVE , --
Owner WASHBURN , RANDY & SUZANNE
TAX MAP Nth . 93 - 2 - 22 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
i
i
3
1I3
i1i
BUILDING PERMIT
V'A7JyFo fi 0 TOWN OF QUEENSBURY No. _ cedes
TAX MAP NOs 93 . — 2 - 22 . 4 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to WASHBURNo RAN
OWNER of property
located at 64A SHERMAN AVE . Street. Road or Ave.
in the Town of Oueensbury. To Construct or place a SE
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.
tk4i 3 RBOrX 64A SHERMAN AVE
QUEENSBURYr NY 12804
7. CONTRACTOR or SO LOE R"S Name
I . B . S . SEPTIC
QUEENSBURY , NY 12804
4. ARCHITECT'S Name
S. ARCHITECT'S Address
6. TYPE of Construction -- fPsaase indicate by Xi SEPTIC
I I Wood Frame f l Masanry i I Steel l F
7. PLANS and Spacifionionts
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
No.
$. Proposed Use
SEPTIC ALTERATION
25 July 23 2000
PERMIT FEE PAID - THIS PERMIT EXPIRES ]9
(if to a before Per mQ4 application
pp rilic ion lor an
datr.ixte�n rnuet be made to t" Suildkv and Zoning impactor of the
nti
23 July 1998
Dated at the Town of Oueensbury this Day of 19
SIGNED BY for the Town of Queensbury
Building and ZOni
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. cj2 - q5
Dept. of Cornm= ity Development
Building & Codes Office 'C>
742 Bay Road Fee Paid $ y
Queensbury, MY 12804
Location of property for installation: J`I r r r+R c. r, U- Loe
Property Owner's Name: /` eN J U L 2 2 1998
Property O w.nnW s Mailing Address: y:WC !" /"L C . -+ r_ ► , +�[ _ �v
Installer's Name: ,L , �J . ,i v t� Phone # j 7S Z 9 c(�
Number of bedrooms (if residential) : Total daily flow: --I -�- —
(residential _ compute 0 150 gal.fbdrm.)
Topography. t, rolling, steep slope 96 of slope
Soil Nature: sand, loam$ clay, other f depth.
Ground water: at what depth?feet f Bedrock or Impervious Material: at what depth? ____ feet
Percolation test: / not required, required [ rate min. per inch ]
Domestic water supply: cipal, well, other
If domestic water supply is a VMLL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
,r e �o s 1f
Septic tank;/�O gallon (Minimum size: 1 ,000 gal.)
Tile field: each trench feet f Total system length: feet
Seepage pit(s): number of � f size each: ft. by fte
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
ALtras system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of d3o Code of the Town of Queenebury, any permit or
approval granted which is based upon or is granted in retuu=o upon any materu d misrepresentation or failure to make a
material fact or circusnatanc+e known by or on behalf of an applicant, shwdl be void.
I have read the regulatkaa with respect to this application and agree to abide by tbese and all requ iromemts of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
,/ AO
���
i
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(519) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
j Dame -�+,� - -- �^
Location ,'7 lea �I��r'�^•••.� - +�
Date -'II `, 3�i Permit #� �-- cG}�
SOIL �fP'E '�� am- Clay-
Resul is of ercal atian Test-
( if applicab e ) Rate- u e/ Inch
TYPE. OF SYS
ABSORPTION FIE` otal ength
Length of ea ch
Depth of t oche � - ---
Size of
SEEPA PITS • umber- -Si ice- ft . x ft .
Stone size _ r _
PIPING : Size hype
Bldg . to Tank .h3^
Tank to Dist . Box
Dist . Box to Fiel Lit
Openings Sealed ? es _ a Wartial
` LO('•ATION/SEPARATI .
Foundation to Tank EA ,'y -; eet
Foundation to Absorption feet
Separation & Pits et
Conforms as per Plot Plan o
LOCATION OF SYSTEM ON PROPERTY :
t
( circ]__e one )
-fir& Suede- Right Side
Middle Front - -19fidarr--- -
COMMENTS:
I
Cr�rFt
SYSTEM USE APPROVED:
Arrived :
i Depart . `
u ` i g s tar
L
JUL 2 2 1998
"I have seen or observe4 or behm I sm Ovidena of,
all ONWft such es boom fir.-'beft ham Ott,
shorn on this document, I abe►- eNrrwtad M hm
-- gram,
% person rt nnesured the di:teaeoes sif ar tlned?ie
TOV SIG ATURE . DATE.
DAT _ - ---
13
(Ott
10
✓�" V C-'1 Gl.' [ I S./ F �' I • L C .!� /ti" M /� ''7� '�J'� {�. a 6 5 r