97-178 CLI�TIFICA'I E OF COMPLIANCE
TOWN OF QUEENSBURY
•
WARREN COUNTY, NEW YORK
Date May 7 19 97
97178
This is to certify that work requested to be done as shown by Permit No.
has been completed.
• This structure may be used as a SEPTIC Al t1'RAI
E' C?N
Location 4 PROSPECT DR.
Owner JENKS , IOD TE C
By Order of Town Board
TAX HAP NO . 91 . - 't--4 TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 9717R
TAX MAP NO. 137 . —2-9. 12ARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HARRIS, KENNETH & JUDITH
OWNER of property located at 36 EAGAN RD. 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
4 PROSPECT DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
CONDON'S SEPTIC & DRAIN
3. CONTRACTOR or BUILDER'S Address
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
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES April 30 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 T n of,ueensbury this 30 Day of April 19 97
SIGNED BYE for the Town of Queensbury
uil g and Zoning I ctor
Application for SEPTIC DISPOSAL PERMIT 0
• STAMP 121C1:1 Vl?1)
•
Location of properly for installation: SI R6SYFc4 PR 0
Owner's Ncunc li1F/t/ giM Q.Lc PERMIT 1.NUMBER i0
Owner's Mailing Address: e Rd OuF61120fy 97-172 (71
/ /1�S p r/ 1 ' PAl I) ,1S.
CG
Installer's Name. F� r C.. Phone #: �L ��7
Number of bedrooms (if residential):
Total daily flow (residential -compute cn 15(1 gal. per bedroom):
Topography: r flat Q Rolling F—] Steep Slope % of Slope
Soil Nature: rxi. Sand Loam Q Clay Other /Depth:
Ground Water: at what depth? t /4 feet -
Bedrock or Impervious Material: at what depth? feel //�� ggyy ,..-..a r
Percolation Test: EX Not Required ( 1 Required/Rate mitt �cRittiio '990
11 TOW O
Domestic Water Su1ply: Municipal �1 Well Q C)lhi:r $ !IM�ANDCODE 1r
If domestic water supply is a WELL: water supply from any septic absorption is feet
PROPOSED SYSTEM:
Septic tank: �Lgal, (minimum size: I.000 gal.) •+J .
life Field: each trench 60 feet. / total system length °� 7 rect.
•
. Seepage Pit(s): number of / size each: • ft. x rt.
Size of stone to be used: # / depth or thickness ` • feet. . • •
HOLDING 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
Qneenshary, any permit or approval granted which is based upon or is granted in reliance upon .
any material misrepresentation or failure to make a material fact or circumstance known by or on
behalf ofan applicant, shall be void.
•
I have read the regulations With respect to this application and agree to abide by these and all
requirements of the Town of Qiceensbury Sanitary Sewage Disposal Ordinance.
Signature of responsih'e person: J "K &1241-44 - • Date: S"--�lq
-7 7
,FRIR
TOWN OF QUEENSBURY 0/71/
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
NameNAY1' )
Location 1-t fyolaprl- „vt,(, ),
J
Date )— -7 Permit #
SOIL TYPE: San Loa' Clay-
Results of Percolation Test-
(if applicable) R te-Minute/Inch
TYPE OF SYSTEM: 4
ABSORPTION FIELD. Total L n tth �-7/�
Length of ench ( Ca
Depth of trenches
Size of stone
SEEP E PITS: 'Number-
Si e - ft. x ft.
tone size
PIPING: r Sze Type
Bldg. to Tank -- 42L 411)
Tank to Dist. Box i 6-n p_U
Dist. Box to Field/P h +1
Openings Sealed? Yes No Partial
LOCATION/SEPARATION .
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits
Conforms as per Plot Plan • No
LOCATION OF SYSTEM ON PROPER 41pfeet
(circle
Front - - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: 11111 NO
Arrived: ,r447)
Departed: --7-7-x
Building Inspector
, __, .;_i: - NI have seen or observed,or believe I saw evidence of,
all objects such as houses,ivels,trees,fencestett,
shown on this document.I also represented!have
personally measured the distances set forth on the diagram."
, . , _?_. , q-2.9-97
.1 .1
SIGNATURE DATE
PLOT PLAN
SEPTIC SYSTEM . . .
Notice: 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.
,--
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