97-628 CERTIFICATE OF .COMPT,IANCI -
TOWN OF UUEENSBURY
• . WARREN COUNTY, NEW 'YORK •
Date n4- -e)1•+4,:s`ri `_°gin 19 c�
.
78
This ,it to certify that work `requested to. be done as: shown .by ,Permit.No,. `
has been completed.
This structure may be used as a • 1sr?'-. -( a�1.3,'�'. ;1� i`t'L hd .
' Location , . 23 lal : 3.-.1) ..OR-
Owner ' B1:tlNO., HARK + DIANE: ,
.
i. . x1,F:f° NO t: . .- By Order of Town Board -' --
TOWN OF QUEENSBURY ' •
a.,/,,,(.,
. " Director of Quilling St. Code .Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No
VALUE $ 0 97628
TAX MAP NO. 125. -9-8 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BRUNO, MARK & DEANE
OWNER of property located at 23 HERALD DR_ Street,Road or Ave.
in the Town,of Queensbury,To Construct or place a PEPTIC 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
23 HERALD DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
CONDON SEPTIC & DRAIN SERVICE
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel 1 1
7. PLANS and Specifications
SEPT1'O ALTERATION AS PER PLOT, PLAN. SPECIFICTIONN>Ykt R
8. Proposed Use
y.v SEP.TIC'_ALTERATION;.
i•- ter 2€�e Gh .)
$ PEF�MITFEEPAID THISPERMIT EXPIR'ES--���� "� t••��'- OCtObe>��,=-2��:U���g�xatf�99s,�yx;
(If a longer period is required an application(or,an extension must be made to the Building and Zoning inspector of the
town of Queensbury.before the expiration date.)
T ��s3N r Octo_ber � 97 y_
Dated at the Town of Queensbury this " baY
,
' —^
SIGNED BY � --� for the Town of Queensbury
Building and Zoni Inspector
Application for SEPTIC DISPOSAL PERMIT
(r
Town of Queensbury Permit Noq -(od--?
Dept. of Community Development
Building &Codes Office C
742 Bay Road " q Fee Paid $(.:17.2..S
Queensbury, NY 12804 / 4#') . I g
Location of property for installation: 2.T / a ��,L�
Property Owner's Name: / U f F o(/t/ 6
Property Owner's Mailing Address: a 3 Hfi/M4..7) 3)4R
Installer's Name: �� ytD�d� S EC,be (7a�Id!/IJ S Phone # P tF.S`/L
Number of bedrooms (if residential): Total daily flow: �j 0®
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: / sand, loam, clay, other /depth:
Ground water: at what depth?�i eet / Bedrock or Impervious Material: at what dep ifeet
Percolation test: __Xnot required, required [rate min. per inch ]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is P feet:fi .
PROPOSED SYSTEM OCT 2 31997
A ey tS4'°
Septic tank: ,5 gallon (minimum size: 1,000 gal.) TOWNr =c:`m` '''��,
_GLENC 1kCdD_,C QDE..
Tile field: each trench Ord feet / Total system length: 3o feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # Z/ / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical work 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 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(, Date: f i' 22J' 7
a , 30
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 •
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
:jfl _________
Date )0 !1 7Permi t #9')-
SOIL TY : Sandi oam-Clay-
Results of Percolation Test-
(if applicable) Ra inute/Inch
TYPE OF SYSTEM:
ABSORPTION F ELD: ota Length I. •
Length of eac tr ch _i��' 1-
Depth of trench
Size of stone
SEEPAGE I : u
Size • t
Stone si e
PIPING: Size Type
Bldg. to Tank
Tank. to_Dist. Box 1-1
Dist. Box to Field/Pit 4" -
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption Q feet
Separation of Pits _- feet
Conforms as per Plot Plan '1'( ;, No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - L ' e - Right Side
Middle Front • le Rea
COMMENTS:
SYSTEM USE APPROVED: NO
Arrived:
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i ding pe or
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