97-317 CERTIFICATE' OF COMPLIANCE
•
TOWN OF QUEENSBURY •
WARREN COUNTY, NEW YORK
Date r„1' � �� 19 7
- 1--t(49 • •
This is to certify that work requested to be done as shown by Permit No. 97317
has been completed. '
• This structure may be used as a SEPTIC ALTEATION
Location 47 PINJ LLO RD.
Owner . ' HALL, LARR l & KAREN
By Order of Town Board
TAX HAP NO. 147 . -i-'70 TOWN OF QUEENSBURY
•
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Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97317
TAX MAP NO. 147 . -1-70 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HALL, LARRY & KJ EN
OWNER of property located at 47 PINELLO RD. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a RFPTTC ATjTFa?14.57ION
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
47 PINELLO RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
I.B .S . SEPTIC
3. CONTRACTOR or BUILDERS Address
2 LOWER WARREN STREET
QUEENSBURY,, NY 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( 1 Wood Frame ( I Masonry ( I Steel (
7. PLANS and Specifications
SE1P•IC ALTERATION AS PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 June 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.)
Dated at the Town of Queensbury this 16 9 7
Day of June 19
SIGNED BY e for the Town of Queensbury
Building and oning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
CI r) -517
Dept. of Community Development Permit No.
Building &Codes Office
742 Bay Road Fee Paid $cl-S. 00
Queensbury, NY 12804
-___—..........._______
Location of property for installntion:
, ,h r---it trzpAnzo
Property Owner's Name: ,? //69/, i c„i W. (-c_ ,
JUN 1 6 1997
Property Owner's Mailing Address: /.1 e (16) tr.-) ' rnte.,:,
i,91..2. 01I._ 'C-Alp.C.QPL
Installer's Name: J di I. f(- ()// C - Phone # )
Number of bedrooms (if residential): 3 Total daily flow:
', rolling, steep_____ "--- slop(reesidentialro-ocof slope
@ 150 gal./bdrm.)
Topography: t
• Soil Nature: sand, loam, clay, other /depth:
' Ground water: at what depth?44feet / Bedrock or Impervious Material: at what depth? feet•
-
Percolation test:/.1Fnot 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
,-/'•--
Septic tank:/eWgallon (minimum,size: 1,000 ,p1.)
' Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of / size each:
_e __ " Kby ft. •
Size of stone to be used: # > / 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.) r•
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 lmown by or on behalf of an applicant;shall be vokl.
I have read the regulations with respect to this appli ' agree to ' by these requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: , D .
•
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT ` '
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (-1)1-6_L
Location /9/,,,LA;Ge_.49 , /O
Date e l//7 Permit # 7r— 3//
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation est-
(if applicable) Ra a-M'n to/Inch '
TYPE OF SYSTEM:
ABSORPTION FIELD: To 1 ength _
Length of each trenc
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
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:
y7Z — L6 7 -6----
•
OK CrJed
SYSTEM USE APPROVED: OYE NO
Arrived:
Departed:
Building Inspector
.?A/' c=b4, 0 J-A-4,-2- ‘- 2. - '
c`--
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road. ,
Queensbury RAY 12804 .
518r745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name kiik--(-- e ..
Locati rerJ
Date 4 4' Permit # 93/7'
Or-
SOIL TYPE• Sand' Loam-Clay-
Results of Percolat. : Test-
(if appl i cabl - Rare- 'mute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each t e h
Depth of trench:s ._
Size of stone
SEEPAGE PI : Number-
Size - . _ ft. x t5 ft. .
Stone size3
PIPING: Size Type
Bldg. to Tank eXf ,/,,
Tank to Dist. Box -VAa p
Dist. Box to /P ' A q
Openings Sealed? No Partial
LOCATION/SEPARATION' .
Foundation to Tank feet
Foundation to Absorption a- feet
Separation .of Pits ." eet
Conforms as per Plot P1 an CO) No
LOCATION OF SYSTEM ON PROPERT
(circle .-)
Front - Left Side - Right Side
Middle Fron - Middle Rear
COMMENTS:
a. Pe*.(--(.�
.4.2,-7----A471.6/0
SYSTEM USE APPROVED: YES 0
Arrived: S e .e5 .
Departed:. .
4
Building Inspector
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:1/P TOWN OF QU - „ BURY
gy D!q; ll ii T 3 n1%a{?,j/T a .,
l
DAT E
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seen or observed, or believe 1 sew*videos(
such SS Douses,wells,thee,fogey etc,
_ k, isailit .. '. • IOW ,, 0
Mtn.r
\_ TOWN OF QUEENSBURY BUILDING DEPARTMENT
Based on our limited examination,
compliance with our comments shall
( K(‘
not be construed as indicating the
plans and specifications are in full
compliance with the code.
i
fof