97-587 • CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 17 19 07
3ö1 joio 97587
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
33 MAIN
Location
3ONLiS e EARL ex, JOYr'C:}j
Owner
TAX MAP NO . 1.30. —3- 34 By Order of Town Board
OWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING .:PERMIT
TOWN OF QUEENSBURY
VALUE . $ 0 :_, . No. 97587
TAX MAP NO. 130. —3-34 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to JONES. EARL & JOYCE
OWNER of property located at . 33 MAIN ST. 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
33 MAIN ST.
QUEENSBURY; NY= 12804
2. CONTRACTOR or BUILDERS Name .
SANITARY SEWER
3. CONTRACTOR.or BUILDERS Address .
DAL DRELLOS PO- BOX 224
AGLENS°,FALLS =NY. 42801
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
•
( )Wood Frame ( )Masonry ( )Stee$E 1ITIC
7. PLANS and Specifications
SEPTI . ALTERATION AS. PER PLOT PLAN.,SPECIEICA,TIONS, .r.:J -
8. Proposed Use
SEPTIC, ALTERATION;_..,..;
$ 254P PERMITFEEAID-THISPERMIT-EXPIRES - October-,9.
(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.)
9 97
Dated at the Town of Queensbury this' �� Day ofj"� � October r.,19
l
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector.
Application for SEPTIC DISPOSAL PERMIT
I l
Town of Queensbury Permit No. / ,D'7
Dept. of Community Development
Building&Codes Office n Q()
742 Bay Road Fee Paid $C95
Queensbury, NY 12804
Location of property for installation: d"/ /4/ RECEivcD
TI
Property Owner's Name: OCT 0 81997
_ Property Owner' Mailing Address: 3 J 4/47 /� TOWN OF QUE N�BURV
t3uiwING AN CODE-
Installer's Name: /(} TA/ Gt��� Phone # �� %) / �c�
Number of bedrooms (if residential): Total daily flow:
(residential -compute @ 150 gal./bdrm.)
Topography: „r2L flat, rolling, steep slope % of slope
• Soil Nature: 0( sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _feet
Percolation test: not required, required (rate min. per inch]
Domestic water supply: i'c municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
•
PROPOSED SYSTEM
Septic tank 1000 gallon (minimum:size: 1,000 gal.)
Tile field: each trench feet / Total system length: ' feet
Seepage pit(s): number of / / size each: r® ft. by 8 ft. '
Size of stone to be used: # / depth or thickness feet
•
HOLDING TANK SYSTEM:. (if required)
Number of tanks: Size of each: gallons
• CAlarra system and associated electrical Sark to be inspected by a certified agency.) •
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 ciicumstance known by or on behalf of an applicant;shall be void.
I have read the regulations with to and abide by these and all requirements of the Town of
Quee Sanitary nsbury Dispo
� C,1
Signature of responsible person: Date: I -
-
p?,/, ; C6- 1)
TOWN OF QUEENSBURY -74 =
BUILDING & CODE,,ENFORCEMENT Atija
742 Bay Road `'i�
Queensbury NY 12804 1i43 o
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name CYoNi2,5
c
Location _ 33 �`
Date/ — '%1,,.® rmit # 9 !- D�� _
SOIigip Sand-oam-Clay-
Results of Percolatio Tes -
(if applicable) Rate-Mi ut /In h
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Le th
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS,: Number-
Size - 145 ft. .x %- ft.
Stone size 4,3
PIPING: J 'ie Type
Bldg. to Tank C( 7 ✓t
Tank to Wit,—&m( f ' ' -2
Dist. Box to Field/' ' -
Openings Sealed? No Par ial
LOCATION/SEPARATI I .
Foundation to Tank feet
Foundation. to Absorption la9feet
Separation of Pits _ feet
Conforms as per Plot Plan Ye No
LOCATIO SYSTEM ON PROPER
(cir.cl ne,
Front - Rear - Left Side - Right Side
Middle - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: Y S NO
Arrived: /°-."5
Departed: gi_z_K
Building Inspector.,
•
l�
7 'GO "i have seen or observed, or believe I saw evidence of,
®ZI ,,5R‘I all uses, wells, trees, fences, etc.,
,� ;;�o� s! • �.Gnt. I also represent that I have
\-co 0‘
?,lGNA—r• •� . . "
TOWN OF QUEENSBURY BUILDING DFrARTMENT
pfotBased;� on our limited examine.,ion.
'��/ compliance with our comments shall
L not be construed as indicating the F
plans and specifications are in full
compliance with the code.
ID
, IP\ 7.7 -T-A iti/c__
ILE C �
TOWN c• •UE NSBURY
B, ALDli‘ 81 CC ":,. DL P a,l
REVIEWED BY _
DATE /O - D(LG trey Ai
1
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