97-209 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 29 19 97
/o / 3 & 7 ,
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC" ALTERATION
• This structure may be used as a
Location 79 SARAH-JE M DR
Owner NADIG PHILLIP & BONNIE
`t'A �'i<�&' idCl , 7 ?• . -43 By Order of Town Board
TOWN OF QU N URY
•
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No.
VALUE $ 0 97209
TAX MAP NO. 74 . -2-43 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to NADIG PHILLIL & D-O-R IE
OWNER of property located at 79 SAIZAII JEN DR. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC AL I ERAT ION
at the above location in accordance to application together with plot plans and other in ormation hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNERS Address is
79 SARAH—JEN DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
MATTHEWS , JOHN
3. CONTRACTOR or BUILDERS Address
3219 ROUTE 9L
LAKE GEORGE , NY 12845
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
G.EPTIC
( )Wood Frame ( 1 Masonry ( )Steel l SI
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
B. 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 Oueensbury before the expiration date.)
Dated at the Town sbury this 1 bay of May 19 97
SIGNED BY -- for the Town of Oueensbury
Building nd Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury RECEIVED
�'j
Dept. of Community Development Permit No. i
Building &Codes Office MAY 0.7 1997
742 Bay Road Fee Paid $
QnPpnsbury, NY 12804 TOWN OF Gtuai:t3S3URY
BUILDING AND CODE
Location of property for installation: Le - 14 3 skeL
Property Owner's Name: ` I. ) AlA4,,
Property Owner's Mailing Address: A5SF.vnrS(y 1901,.,iT- 1 )^A— S,D-e L4 e
Installer's Name: FR•e.vo-t Phone # 9(tS-I21 a
Number of bedrooms (if residential): 3 Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: X flat, rolling, steep slope % of slope
Soil Nature: x sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, x required [rate min. per inch
Domestic water supply: K municipal, \ well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. r
PROPOSED SYSTEM l d mod,c.` TU pVlA-SCE ,„k F�„Z Pm ,
Septic tank: /,250 gallon (minimum size: 1,000 gal.) Jkts re"- `l
Tile field: each trench feet / Total system length: 0200 feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # / depth or thickness /,,j feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CAlarm 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: Q4-14/1 Date: 4/6A 7
62)ti
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
ame ' 1-, I , r4�
4 .040611 i 4* --11. -..' *. t--1 lip
' Lel- J 6,--4 ES&4
Da '- 1 Permit # iIg )-6/
SOIL TYPE: Sand- oa -ClaY- ! G
Results of Percola 'on Test-
(if applicable) Ra e i ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length 0,2,
Length of each ench ' . �C�' ��
Depth of trench s 2' 1 --c-\ --
Size of stone ' 7.—
SEEPAGE PITS: Saber-
Size - ft.
Stone size _
PIPING: Size Type
Bldg. to Tank ___ __
Tank to Dist. Box LI" WC--
Dist. Box to Field/Pit \_ % '%PE
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank 6trrs- feet
Foundation to Absorption 1� feet
Separation of Pits eet
Conforms as per Plot Plan . 441110No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left ide - Right Side
Middle Front - u file Rea'
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Depar °
ilding s ector