97-216 •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 'Pia,/ 16 19
7
97216
This is to certify that work requested to. be done as shown by Permit No.
has been completed.
SO
• This structure may be used as a ?'}'.t'IC P LiL,PT3, rt
Location 6 NORTH WOOD DR.
Owner URlt:[CO , BOY CZ SUSAN
By Order of Town Board
TAX HAP NO, :37 . 7 // TOWN OF QUEE SBU Y
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY Na
VALUE $ 0 97216
TAX MAP NO. 37 . —4-1 . 7 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to URRICO, R0-Y & SUSAN
OWNER of property located at 6 NORTHWOOD 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
R. D. #3 BOX 3181
LAKE GEORGE , NY 12845
2. CONTRACTOR or BUILDER'S Name
SIGNORELLI & SON
3. CONTRACTOR or BUILDER'S Address
589 WEST MOUNTAIN ROAD
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
S.
( 1 Wood Frame ( 1 Masonry ( 1 Steel 1
EPTIC
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES May 12 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 Town of sbury this bay of May 19 97
SIGNED BY rl t for the Town of Queensbury
Building a Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
r
Town of Queensbury Permit No. 9 7-7
Dept. of Community Development
Building &Codes Office oc;
742 Bay Road Fee Paid $c S;
Queensbury, NY 12804
Location of property for installation: 097 10,2A ui i Dkiiie
Property Owner's Name: U l e'0 /ZO v 't SUS A-x
Property Owner's Mailing Address: S 4'i .
Installer's Name: _ 12 1 c) ,,/l if/ad�'J�1r Phone # 7 ,l / 00
I I
Number of bedrooms (if residential): 3 Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth? 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
exSisl/may /
Septic tank: (C gallon (minimum size: 1,000 gal.)
RECEIVED
Tile field: each trench .. O feet / Total system length: _ /a feet
MAY 071997
Seepage pit(s): number of / size each: ft. by ft x
1 G AND CODE
Y
Size of stone to be used: # / depth or thickness / / fe BUILDIN
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CAmfhnl 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 Sanitary Sewage Disposal Ordinance.
Signature of responsible person: 'y Date: re "72
TOWN OF QUEENSBURY I
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 1
(518) 761-8256 •
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 0 \r-v i l',C) ��r : i.
Location ( ? \Tftc c . rin
Date &- its-9 7 Permit #C1- al L
SOIL TYPE- Sand- oam-Clay-
Results of Percolation Test-
(if a .lica+le) Rate-Minute/Inch
TYPE 0" S 'TEM: C p F-
ABSORPT `,�±'' FIELD: Total' Length -Z_r3
Length I each trench Alp r
Dept of enches Zt — 31
Size of stone Z
SEEPAGE PITS: Nu r-
Size - f -------ft.
Stone size
PIPING: Size Type
Bldg. to Tank .tic.-ViTiali
Tank to Dist. Box fir''
Dist. Box to Field/Pit Ai" p1/41 F-
Openings Sealed? No Partia
LOCATION/SEPARATIONS:
Foundation to Tank -�V feet
Foundation to Absorption t5- feet ,;i,�
Separation of Pits feet L»J,
Conforms as per Plot Plan Yeses
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
►^r1 Rear t ft Sidy Right Side
e rat- Middle Rear
CONMENTS:
SYSTEM USE APPROVED:
Arrived: t ,r ,
Depar -1 a
B.ilding I -ctor
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road ,6:
Queensbury NY 1280
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSP CTION
Name 0VV- \ ('2) gcR)9,6
1
Location (p N)c ra- 3Y)
Date 5—�9-97 Permit # 9"7 7c2ip
SOIL TY San - oam-Clay
Results of Percolation Te t-
(if applicable) Rate-Minut nch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total e gth
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: { ��
Size Type
Bldg. to Tank 61-V � �
Tank to Dist. BexofiVs` """1
Dist. Box to Field/Pit k �pE
Openings Sealed? Yes • No Partial�w ,
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side Right Side
Middle Front - Middle Rear
COMMENTS:
t � ` \ t
<S7P t' _\y34s.Zi
SYSTEM USE APPROVED: YE NO
Arrived:
Departed. �.^
ilding Insp t r
TONN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name U F,D,1
Location _ (p' •130R71-1tOM rn
Date 5 r14197 Permit # C-1-1--ZC
SOIL TYPE: Sand-Loam-Clay-
,
Results of Percolati , - •.t-
(if applicable) Ra a%Inch,
PE STEM:
A ORPTION FIE r: Tot.Length
Length of eac trench
Depth of trenches
Size of stone
S Nu
Size - ft. x ft.
•ne
PIP G: Size Types e
Bldg. to Tank
Tank to Dist. Box
Dist.. Box to Field/P'-. 4. � t'
I'enings Sealed? ficr No Partia
L0 i /SE' 'i, ONS
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:T ,rl ,.,
SYSTEM USE APPROVED: YES
Arrived:
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �.41G. 1.1.,1 1., f2NR1C
Location — -�LZOCA)
Date SI-i}C�n Permit #
SOIL TYPE: Sand-Loam-Clay- 1'!c/ l/7
Results of Percolat'on Test-
(if applicable) at Minute/Inch
TYPE OF SYSTEM: '
ABSORPTION FIELD: T tal Length
Length of each tre ch
Depth of trenches
Size of stone
SEEPAGE PITS: mb r-
Size - ft. x ft.
Stone size
PIPING:- Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrive. ' >� ;
Dep. - :;010tilyL;)1(
r Building :'n`,ector
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