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97-727 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date December 11 19 97 g97727 This is to //ertify that work requested to be done as shown by Permit No. has been completed. This structure may be used as a SEPTIC ALTERATION Location 54 MASS.. AVE. Owner CORDIALE, ANDREW & HELEN TAX HAP NO. 128, -3-9 By Order of Town Board TOWN OF QUEENSBURY Director of Building & 'Code Enforcement BUILDING .PERMIT VALUE $ 0 TOWN OF QUEENSBURY No 97727s TAX HAP NO 1. 1.28.—3-9 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to _ CORDIALE, ANDREW & HELEN OWNER of property located at 54 MASS. AVE. Street, Road or Ave. in the Town of Queensbury,TO Construct or plaoa 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 54..:•MASS AVE - QUEENSBURY. NW,- 12804 2. CONTRACTOR or BUILDER'S Name S _SEPTIC 3.3. CONTRACTOR or BUILDER'S Address•_< 2: LOWER WARREN STREET IQUEENSBUAYr. NY E, 1: .80.4. 4. ARCHITECT'S Name 6. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) -3EP_TIC . ( )Wood Frame ( )Masonry ( )Steel I I 7. PLANS and Specifications .� SEPTIC:-ALTERATION AS :;PER_ APPLICATION ..,. rv... 8. Proposed Use - 1L,SEPTICt—ALTERATION „ ,h4; 99*ci, $ PERMIT FEE PAID —THIS PERMIT EXPIRES 19 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Oueensbury before the expiration date.) - _:._ . Dated at the Town of Queensbury this Day.of 6 19i3 SIGNED BY for the Town of Queensbury Bu i and Zoning Inspector r Application for SEPTIC DISPOSAL PERMIT r Town of Queensbury a7 Dept. of Community Development Permit No. Building &Codes Office 742 Bay Road Fee Paid $ Queensbury, NY 12804 J / y, Location of property for installation: I( cs(A,C 4 a� 6�S Gt_, C-, C_. Property Owner's Name: ,4 \ o f`(_(A) c„./ • Car-d,s.a.- Cc, Property Owner's Mailing Address: #f r / ' > Cti c(,,_,ieT 7—� C -e-'c__ Installer's Name:j c 0, f J2/a// Phone # ?9r- -19r Number of bedrooms (if residential): Total daily flow:71) 0 �C (residential - compute @ 150'a e.(l./bdrm.) Topography: �f1a, rolling, steep slope % of slope Soil Nature: sand, loam clay, other /depth: Ground water: at what de . feet / Bedrock or Impervious Material: at what depth? _feet Percolation test: not required, required [rate min. per inch] Domestic water supply: mu‹.--'nicipal, well, other If domestic water supply is a WELL, water supply from any septic absorption/is 4 1'N 'l,feet:- k ; r, . .., PROPOSED SYSTEM DEC 101997 : ,qy Septic ()O O gallon (minimum size: 1,000 gal.) TOW,Bb+_t dNlLAmat owe Tile field: each trench 3 J feet / Total system length: NO feet Seepage pit(s): number of / size each: ft. by ft. Size of stone to be used: # / depth or thickness / feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each: gallons CAlarm 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 a p• 'cation and agree to abide by these and all requirements of the Town of Queensbury::po::: Disposal •,: Date 2-1? Sgnature person: ITAiks.,(2.(2,c71, TOWN OF QUEENSBURY Pant. ' BUILDING b CODE ENFORCEMENT_- J 742 Bay Road �� Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name e_pyyC-.Q Location _ S Date ` ) /4-q 7 Permit # -7- 7c SOIL TYPE: San Loam-Clay- Results of Percolation Test (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length AM Length of each trenca Depth of trenches £<� Size of stone 111111k, SEEPAGE PITS: Numblillligh Size - ft. ximiumft. Stone size !��'e PIPING: Size T e Bldg. to Tank �- y" G Tank to Dist. Box Dist. Box to Field/P' %' " C, Openings Sealed? O No Partial LOCATION/SEPARATION : Foundation to Tank /0 feet Foundation to Absorption ap feet Separation of Pits _}4 —, eet Conforms as per Plot Plan No LOCATION OF SYSTEM ON PROPER . (circle Front -r") - - Right Side Middlent = Middle Rear COMMENTS: SYSTEM USE APPROVED: NO Arrived: /0'//( Departed: I I i f I I� I_ I I I 1 1 i I I ■■ I ■ I I iiiiinil IMEM , • 4 ,_ _. :ma =_ 1111 -C . .B �■.1. . - II _ �_ -iii■.■■.U. 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