97-232 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 20 . 19 97
11;)
97232
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 rIL'`1 E 1 fir}N
Location 9-1.2 WEST lIT. 4:r�.
Owner WOODCOCK, E.r.'t.-E N 6._ POSTER
TA MAP i 0. . 3. _2_7 ,.i By Order of Town Board
OWN OF QUEE U Y
Director, of Building & Code Enforcement
Application for SEPTIC DISPOSAL PERMIT
^ �
Town of Queensbury
Dept. of Community Development Permit No� 1'� �
Building &Codes Office
742 Bay Road Fee Paid $ • °a
Queensbury, NY 12804
Location of property for installation: ?1 (,Jes /111,. g61.
Property Owner's Name: F6.6 -2L,,,,, Poo oC cos,k
Property Owner's Mailing Address: 97a Gsies? h P . gc(�. 416e ci"r
• 7
Installer's Name: 3;& <;.o-e 4- 6K,s -/iuc lid.
'1 Phone # -1 cREGFA/ED
I
MAY 141997
Number of bedrooms (if residential): 1. Total daily flow: j 71 °' ^, Y
TOWN C'"Uf;_�/}-,"v° st
(residential - com�putq�a aari59.T. r`�s�
Topography: flat, rolling, steep slope % of slope
• Soil Nature: X sand, loam, clay, other /depth:
Ground water: at what depth?ahx. feet / Bedrock or Impervious Material: at what depth? _feet
Percolation test: 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
L:.h'''C;•j0>2s
Septic tank gallon (minimum,size: 1,000 gal.)
Tile field: each trench 60 feet / Total system length: 1 k 0 feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # a / depth or thickness / feet .
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: • gallons
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 in reliance upon any material misrepresentation 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 these and all requirements of the Town of
Queensbury Snmtary Sewage Disposal Ordinance.
Signature of responsible person: W/4---- �j.. Date: 5f/i Y/9
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97232
TAX MAP NO. 83. -2-7 ' 2-vv2—ARREN COUNTY, NEW YORK
PERMISSION is hereby granted to WOODCOCK, EILEEN & FOSTER
OWNER of property located at 912 WEST MT. 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
912 WEST MT. RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
JON SWEET CONSTRUCTION
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
SEBEIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 May 16 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.)
16 May 97
Dated at the Town of Queensbury this Day of 19 - .
SIGNED BY _ for the Town of Queensbury
wilding and Zoning Inspector
/ ", k)--• .c7joi ,_, ,
TOWN OF QUEENSRURY
BUILDING & CODE ENFORCEMENT
531 Bay Road. .
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
� ,�Q
Name VC-PM� � ,c1 (
1 k
Location • 6/a•tAkt, M d'. Pczt
Date r-c) 4.7 Permit # % 7' 02 3
SOIL TYRt: an ,Loam-Cl -
Results of Percolati n Test
(if applicable) Ra -Mi ute Inch '
TYPE OF SYSTEM:
ABSORPTION FIELD: otal ength , ,� �.
Length of each tr nch -z (
Depth of trenches ill-L s° �-
Size of stone . --z._.._
SEEPAGE PITS: Number-
Size - .-
Stone size
PIPING: Size Type
Bldg. to Tank o 0
Tank to Dist. Box ti
Dist. Box to Field/Pit II REM
Openings Sealed? Yes No artial
LOCATION/SEPARATIONS:
Foundation to Tank -feet
Foundation to Absorption 1 11-feet
S r s
Conforms as per P1 of P1 an � N_o
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front ft Side-,kight Side.
Middle Front - Mid e Rear
COMMENTS:
UM . ' '
&bt S
3 - .
SYSTEM USE APPROY D: IIIM NO
Arrived: 1, lb ' ' `.
Depar -ii Z` ,. '
,_ Lam _/
/B`.ilding In 'or
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