97-326 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY; NEW YORK
Date June 18 19 97
97326
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
6 CARLTON. DR. --
'Location
PALMER, RUSSELL & DARLENE.
Owner .
TAX MAP NO, 72. . _17 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97326
TAX MAP NO. 72 . —5-17 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to PALMER, RUSSELL & DARLENE
OWNER of property located at 6 CARLTON 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
6 CARLTON DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
PALMER, RUSSELL
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( )Steel ( 1
7. PLANS and Specifications
SERNIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 99
PERMIT FEE PAID —THIS PERMIT EXPIRES June 18 19
(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.)
18 June 19 97
Dated at the Town of Queensbury this Day of
SIGNED BY ,IMS for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
7i
Town of Queensbury Permit NoP('3oL.-S,0
Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $c2S: 6 C)
Queensbury, NY 12804
__
Location of property for installation: (p ailicii_j_c___
Property Owner's Name: '1 \ '+- G1 nC- 1--)ci(1)
Property Owner's Mailing Address: (p [J ✓1't-c i c7)v' .
Installer's Name: c-milt c.3 . �G\,rc,tc--7 Phone # n� 6 9
Number of bedrooms (if residential): Total daily flow: .S(o
(residential - compute @ 150 gal./bdrm.)
Topography: t, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other/depth:
Ground water: at what d pth?-4fr feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate min. per incj
tl '
Domestic water supply: }c municipal, well, otter �.
` JU 97 If domestic water supply is a WELL, water supply from any se�-ec absorption is � � e _
ITOM%i O{`Quii:_i`f .:3
PROPOSED SYSTEM �t1l�Y
CODE
Septic tank: gallon (minim•um size: 1,000 gal..)
r /1
Tile field: each trench 7 '_eg feet / Total systemth: / -1 ( feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Crm system and associated electrical work to be inspected by a certified agency.
J
For your protection, please rote that pursuant to Section 136-29 of the Cade 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 mod.
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,,g.� g, .r GNI,,,,� Date: (I W (la'7
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Nameyosco...Q ,l/L0L
Location le (7 e, 01,-)0,
Date '- Permit #9: )-3,af
SOIL TYPE• s-Loam-Clay-
Results of Percolation Test-
(if applicable) R. • a inute/Inch
TYPE OF SYST ,A)
EL
ABSORPTION' 11: To .1 Leg 0,
Length of nth rent 1 77
Depth of tren. -s
Size of ston-
SEEPAGE PITS. Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank �j�/�j JJ
Tank to Dist. Box •' cJ
Dist. Box to Field/Pit " <,
Openings Sealed? Ana No Partial
LOCATION/SEPARATIO
Foundation to Tank 10_ feet
Foundation to Absorption feet
Separation of Pits . eet
Conforms as per Plot Plan 400 No
LOCATION OF SYSTEM ON PROPER'
(circl -
Front Reif - Left Side - Right Side
Middle ront - Middle Rear
COMMENTS:
Copk/9L6-7t— G6L,O C - '
SYSTEM.USE APPROVED: YES NO
Arrived: / A-ce—
Departed: f ;2
Building Inspector
TOWN OF QUEENSBURY -
BUILDING & CODE ENFORCEMENT' .
531 Bay Road'
Queensbury NY 12804, ;
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name gL446%2
Location , avuTD9 O..
Date f?,XL 7 Permit # l7� ' 26
SOIL TYPE: Sand-Loam-Clay-
Results of Percolatio- est-
(if applicable) Rate Min to/Inch
TYPE OF SYSTE :
ABSORPTION FI LD: . T,tal Length _
Length of each e ch
Depth of trenches
Size of stone
SEEPAGE PITS: Num'ier-
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
LOCATI4 OF SYSTEM ON PROPERTY: -
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
OVTh •
SYSTEM USE APPROVED: (/'-" )YES NO
Arrived: L 4)7'
Departed: f : yj`.
l
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name And
Location OW-C �' a!,
Date ( l 6' Permit # ° 4/6
SOIL TYPE: Sand-Loam-Clay- T'7 --3c 4 116
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD. Tot ength
Length of each t nc
Depth of trenches
Size of stone
SEEPAGE PITS: Num er-
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:
a
66177 -
4)spxoc;7704) //al(
•
06001 laur /Atkavd001
SYSTEM USE APPROVED: YES NO 1
Arrived: 4 'r/5
Departed: //,'c
Building Inspector
Web Graphics
_ ,_,' . DARLENE PALMER
SENIOR ACCOUNTANT, EXT. 401
JUN l 8 1997— - n_ __- di 44-4,1
. TOWNOF QUEENSf3URY 'i//c)6
- __ __BUILDING AND_CODE__�._
0 - _ ,-ter - _ _ C
o : -f=___ ___�
—_ - " to sei or-observed;or=bedeve-t saws eviden> t _. ----
$cts such as houses, wells]trees,fences,etc.,
OtiOir r this document:i also present th tihm
w1e the distee s sate 0rth on_thesdy nt: :..
:040.01.6.211.1FIE _ .. - OA E----------1. Thio\iiiviv4--$41'L.-----,.L____ ____-_.. ......\4.......\ , ,
CORINTH ROAD • QUEENSBURY, NEW YORK 12804
P.O. BOX 308 • GLENS FALLS, NEW YORK 12801
(800) 833-8863
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