97-646 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date IzFarntI r 2 19 97
\, • —7 -) 3
97646
This is. to certify that work requested to be done as shown by Permit No.. _
has been completed.
SEP
This structure may be used as a TIC: ALTERATION
Location 4 CENTENNIAL DR.
Owner YANNOTTI, ARTHURC& NAN '
HAP NO.
3 2 r By Order of Town Board
TAX TOWN OF E BURY,.,�,q,.,
Director of Building & .Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 , No:
97646
TAX MAP No. 80. -2-18 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
YANNOT T I, WI= & =NC?
OWNER of property located at 4 CENTENNIAL DR. Street. Road or Ave.
in the Town of Queensbury,To Construct or place a
T/C ALTERATUN
at the above location in accordance to application togeAFrPvvitn plot pans anaT-ot n-er information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
:• 4 CENTENNIAL DR..
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAR,...DRELLOS PO BOX 224
: -GLENS' -PALLS, NY 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( I Masonry C )stePERVC
7. PLANS and Specifications
EFT rEf'ILLT E RAT roN':'-"AS PER .PLOT -PLAN
8. Proposed Use
„„,
$ 'Ifitikftilt*EVO;k1DTHISIRERMITAEXPIRESun g5'1<') *October 29 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 411.-e4,-,,ivaaY,14-,vig.,----,.-QCtiOb
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
_ Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No.
Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 128(34
J
Location of property for installation: l CeN i eAJAi t b/L RE I V
ED
Property Owner's Name: &i(�c�1z_ /A ,00 77`i OCT 2 9 1997
,fig TOWN OF:OUE.L' ,,1RY
Property Owner'sr' Mailing Address: lz ' RIflLDING AND CODE
Installer's Name: CPA- r T-!), 7 .Thcv e.. Phone # 7 - 7 a�5
Number of bedrooms (if residential): Total daily flow: 60 3
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
• Soil Nature: oZ 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: imunicipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. •
•
• PROPOSED SYSTEM
Septic tank F gallon (minimum:size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of / size each: ft. by ft. •
•
Size of stone to be used: # 2- I 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 to ;.:: application and abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Dis sal :• • . .
Signature of responsible person: 6)(4, ;. �Z f1 Date: 9— / 2
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
. 742 Bay Road
Queensbury NY 12804 •
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 11 N,tAJ -- -�
Location U C .ECl Flv116Nt1.- OK .
.Date 1 `-73- 97 Permit # q-7-(QL Q
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: T: : Length
Length of each tree
Depth of trenches
Size of stone
SEEPAGE PI`f'S.• Nu ber-
Size - ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. B.x
Dist. Box to F/eld/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:
11-. o h-1 _V C ?1(ze,a).e,
SYSTEM USE APPROVED: NO
Arrived:
Departs. - AIIIL ,, joe-'
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TOM OF QUEENSBURY k�
BUILDING & CODE ENFORCEMENT � �
742 Bay Road O, i
Queensbury NY 12804 ° "CJUj
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,q n C9A1 kjiir
Location 1)1\ Q
Date 'i ,-1 I Permit • 974 l" V
SOIL TYPal a,-
Results of Percolation fest-
(if applicable) R te-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length 75t)
Length of each trench -;
Depth of trenches \ �(�t
Size of stone
SEEPAGE PITS: Number
Size - ft. - _ ft.
Stone size \
PIPING: Size Type
Bldg. to Tank = �.-j-i ,�,
Tank -to-Di-st. -Box- - -14ti7�7i�i
Dist. Box to Field/ it k
Openings Sealed? es o Partial
LOCATION/SEPARATION. :
Foundation to Tank • — feet
Foundation to Absor tion feet
Separation of Pits _ feet
Conforms as per P1 o Plan Yeses
LOCATION OF SYSTEM N PROPERT :
(circle one)
Front - Rear - Left Side - Righ Side
Middle Front
COMMENTS:
•
SYSTEM USE APPROVED: NO
Arrived: o
Depar
`Building ns ector
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TOWN OF QUEFfmSBURY
1 i ReCFR/FD
OCT 2 9 1997
1 TOWN of QUEL',..S6LIRY
REVIEVIC-D ny
BUILDING AND CODE
- — — A-:-G--
DATE ________ Ibisoo• A
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