98-770 CERTIFICATE Ol.i' COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Date December 16 19 98
98770
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 62 HELEN DR .
RIVERS , SHAUN & MARILYN
Owner
TAX MAP NO . 90 . - 4 - 68 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBUR`r'' No .
TAR KAP NO . 90 . - 4 - 68 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to RIVERS
OWNER of property located at
62 HELEN QR . Street, Road or Ave.
in the Town of Queensbury, To Construct or place a
at the above location to 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.
i. OWNER'S Address is
62 HELEN DR .
QUEEN.SBURYr NY 12804
2. CONTRACTOR or BUILDER'S Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
LIAN 10RELLO S PO BOX 224
GLENS FALLS NY 12801
4. ARCHtTECT'S Name
5, ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by Xi ,SEPTIC
( I Wood Frame ( ) Masonry ( 1 Steel { }
7. PLANS and Specifications
SEPTJC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
s. Proposed use
SEPTIC ALTERATION
25 December 15 19 2000
$ 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.l
15 Lyecembeer 19 1998
Dated at the Town of Queensbury this Day of
for the Town of Queensbury
SIGNED By Building`"'� Building and Zanirq lnspeactor
�- --- -� Application for SEPTIC DISPOS.A►.L PERMIT
Town of Queensbury Permit No. 9-
Dept. of Community Devesiapment
Building & Codes Office C
Fee Paid $
742 Bay Road
Qucensbury, NY 12804 II
Location of property for installation: 2 - bfzi
Property owner's Name- AU , j �+y' C'ieSr
Property own 's Mailing Address:
- Installer's Name- +' R ► 1 T7NI- A F A-• e_w_.. Phone # 7 `?, - 2
Number of bedrooms (if residential): Total daily flow.
(residential - compute Q 150 gal.Ibdrm.)
Topography: flat, roffing, steep slope % of slope
Soil Nature: sand, loam, clay, od= / depth:
Ground water: at what depth9 feet f Bedrock or Impervious Material: at what depth? ,_,_ feet
Percolation test 'Z.. not required: required [ rate min. per inch ]
Domestic water supply: municipal, well, odser
If domestic water supply is a WELL, water supply from any sepric absorption is feet.
PROPOSED SYSTEM
Septic tank acwl gallon (n1jaimum. size: 1,000 gal.)
Tile field: each trench
�R feet I Total system lance= feet
Seepage pit(s): number of 2- f size each: oC` ft by ft.
Size of stone to be used: # I depth or thickness �- feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each.:. goons
Alarm systam and associated alcu��i wvrc to be imapected by a c artifwd a9000Y.
For ple"e now tbut to Section 13&29 of dba Cade of the Town of Qm � 'O
emsbW7r MY pr
SnuAW vAnch is based upon or u granted at reMuice upon mY magi v=xreVcaeG0bd308 or fiuiluxe to make a
material fact orchvu=xL=06 ]mown by or on behalf of as applicant.' sb&U be void.
1 have read the reSulaticros with respect • se ftVh bou and agree to abide by the and all requueemects of the Town of
Queewb=7 wry Sewage
Signature of responsible person: Z— Date. O� r k
TOWN OF QUEENSBURY BUILDING s CODE ENFORC�T t 3 6
531 say Read
518• 745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date v Permit # L
SOIL TYPf:� 'S`a~n m- CI ay-
Results of Percolation ,Test-
( if applicable ) 'Rate-Mn / nch
TYPE OF SYS :
ABSORPTION IELD : T al Len h
Length of ea tr ch
Depth of trenc
Size of sto
SEEPAGE P Number~ � —
Size - :f ft . x _ tt ft .
Stone size 'vk`3
PIPING: - Size ype
Bldg . to Tank t►
Tank to Dist . 'Box „
Dist . Box to Field/Pit t
ar is
Openings Sealed ? esNo
LOCATION/SEPARATION feet
'Foundation to Tank ti an feet
Foundation try Absorp feet
Separation ox Pits es No
Conforms as per Plot Plan
LOCATION OF SYSTEM ON PROPERTY :
( circle one ) - Left Side- - Right Side
Fro
-- Front Middle Rear
SYSTEM USE APPROVED :
Arrived : y�
Depa
Bui ding ect
TOWN OF Q
BUILDING & -: ' 3 EPT.
REVIEWED BY
DATE
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