97-337 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 Q-1
This is to c rtify that work requested to be done as shown by Permit No.
has been completed.
• This structure may be used as a SEPTIC SYSTEM - RESIDENTIAL
Location is KILEY LANE
Owner SEE, W'ILLIAM GLORIA
By Order of Town Board
• TAX MAP NO. SO. -1-25 . 6 TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 97337
TAX MAP NO. 80. -1-25. 36 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to SEE, WILLIAM GC GLORIA
OWNER of property located at 15 KILEY LANE Street, Road or Ave.
in the Town of Queensbury,To Construct or place a $EPIC SYSTEM - RE�flll�l�I'1'11
at the above location in accordance to application togethher wit plot p ans and other In orma ion eto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
15 KILEY LANE
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
HOMETOWN SEWER
3. CONTRACTOR or BUILDER'S Address
623-2453 MOBILE 744-1314
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( )Steep E P(T1I C
7. PLANS and Specifications
No.
SEPTIC SYSTEM - RESIDENTIAL - AS PER PLOT PLAN AND SPECIFICATIONS
8. Proposed Use
SEPTIC SYSTEM - RESIDENTIAL
$ 25 PERMIT FEE PAID -THIS PERMIT EXPIRES June 24 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 Queens4ury4his 4 24 //D of .ne 19 97
(
SIGNED BY c for the Town of Queensbury
Building and/Zoning Inspector
r-- Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury J ' [ _ r ''
Dept. of Community Development ` ` Permit No.q1-332
Building &Codes Office
742 Bay Road JUN .2 41997 Fee Paid $ 02
Queensbury, NY 12804 � Y
TOWN L r�1,� 40:". .. Cl
BUILDWG FAQ
Location of property for installation: /r f(,°% Lr p
Property Owner's Name: c,r-d` S-e
Property Owner's Mailing Address: /S h. /P�/G�. e �u ,� rs�U /1/); /,aka y
Installer's Name: /74/4.-/P T w d, 5etei r - Phone # /,;3 3 -4.f/c.
Number of bedrooms (if residential): 2, Total daily flow:
(residential - compute @ 150-gal./bdrm.)
Topography: flat, rolling, steep slope ,90 of slope
Soil Nature: V(and, loam, clay, other/depth:
Ground water: at what depth? ,,ry feet / Bedrock or Imperv:cus Material: at what depth?,uyfeet
Percolation test: not required, required [rate min. per inch ].
Domestic water supply: P. unicipal," well, a±_er
If domestic water supply is a WELL, water supply from-any sec absorption is feet.
PROPOSED SYSTEM
Septic tank gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system?e igth: feet
Seepage pit(s): number of Z / size each: , ft. by � ft.
Size of stone to be used: # ' 3 / depth or thicker feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CAlarm system and associated electrical work to be inspected by:certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of 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: .C�/!�/�/vO Date: //7y/97
rn
,------i TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ZI\Ar-d,
)) � �L
Location i S G;
Date - 7 Perm i # —( 337
SOIL TYPE: S nd-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: • .1 Length
Length of each tre,
Depth of t`r'-
Size of stone
SEEPAGE PITS: Numbe
Size - ft. x ft.
Stone size _ -
PIPING: Size Type
Bldg. to Tank __ tpc-,
Tank_ to Dist. Box _ H
Dist. Box to Fiel f4MEMW u%:=7
Openings Sealed? !L ► . Partial
LOCATION/SEPARATIONS:
Foundation to Tank fG feet
Foundation to Absorption -feet
Separation of Pits 7L'm feet
Conforms as per Plot P1 an �L�� . o
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
1121rr.. Middle Rear
�TS:
•
SYSTEM USE APPROVED: liallikNO
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Dep.. ted _:.i_
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BUILDINGTOWN OF
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EVIEWED BY 1� �. �"P
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, / • a)' "I have seen or observed Iv sawIevidence of,
... 1 ‘i all objects such as houses, fences,etc.,
4 shown on this docu
t personally measured�R f represent that I have
- 4 f on the diagram."
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