97-425 - - _ •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, -NEW YORK
Date 19
71 1
This Is to certify that work requested to be done as shown by Permit No. 97425_
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location 10 DRONK DR
Owner DE PALO PETER Ec CONNIE
By Order of 'Town Board
TAX -VIAP NO 89 . -3- 1 COWN Of QU S .RY • •
Director of Building & Code Enforcement
•
BUILDING PERMIT •
TOWN OF QUEENSBURY
VALUE $ 0 No. 97425
TAX MAP NO. 89. —3-1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
OWNER of property located at 10 RRC)NI( DR. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTER'TTION
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
10 BRONK DR.
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)
EP(IVC
)Wood Frame ( ) Masonry ( )Steel
7. PLANS and Specifications
SEPTIC°•ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use •
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES July 25 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 Queensbury this 25 Day of July 19 97
SIGNED BY for the Town of Queensbury
Building and oning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit Nog 7' �_
Dept. of Community Development
Building &Codes Office �l p•.Z)
742 BayRoad Fee Paid
Queensbury, NY 12804
Location of property for_ installation: i' 0 Rt.-0 /1 fr'
P rtyPC `I�Pro a Owner's Name: �C� /v1 i'c.
Property Owner's Mailing Address: #/'O( i'i / c''i�;-�. JUL 2 4 1g97
n, WRY
Installer's .,2* ,)V 5I3 1 Phone #
Number of bedrooms (if residential): ) Total daily flow: .CO
(residential - compute @ 150 gal./bdrm.)
Topography: , rolling, steep slope 7 of slope
• Soil Nature: sand, 1 clay, other/depth:
Ground water: at w dap /7 feet / Bedrock or Impe:ti_cus Material: at what depth? _ feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: municipal, well, ether
If domestic water supply is a WELL, water supply from any sectic absorption is feet.
PROPOSED SYSTEM
Septic tank:/to O gallon (minimum size: 1,000 gal.)
Tile field: each trench feet ' / Total system'e gth: feet
Seepage pit(s): number of / size each: ft. by
Size of stone to be used: # 3 / depth or thickess / feet
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical Rork to be inspected by a 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 that misrepresentation or failure to make a
material fact or circumstance known by or on behalf of an applicant, shall be itaii
I have read the regulations with respect to this app. and agree to abide b r these and all requirements of the Town of
Queensbury Gpr++pry Sewage Disposal G2f `///?
Signature of responsible person: Date:
1
TONN OF Q E SB RY ;;:), 3eD
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name RQNJ\ QO)
Location /(,) AeYn1,�1kAA.A)- 0
Date7"Z-1( 7 Permit #q)rr/
SOIL TYPE: San -Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minut-. Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To •. - •
Length of trench
Depth trenches
Si of stone
S PAGE P T Numbe -
Size - � ft. x O 0 ft.
Stone size
PIPING: Sze Type ./
Bldg. to Tank g t 5 ) ?e..)
Tank to Dist. Box a 1,1 id
Dist. Box to Field y a
Openings Sealed? 01
No Partial
LOCATION/SEPARATIi.
Foundation to Tank / T feet
Foundation to Absorption feet
Separation of Pits ;� ,eet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPER"
(circle = -
Front Re Left Side - Right Side
Middle •ront - Middle Rear
COMMENTS:
•
1111
SYSTEM USE APPROVED: NO
Arrived: ,`,, ;(-
ip__
Departed:
Building Inspector
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