97-742 CERTIFICATE : OF COMPLIANCE
TOWN Of QUEENSBURY
WARREN COUNTY, NEW YORK
Date : December 23 19 97
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17742
This is to certify that work irequested to. be done as shown by Permit. No.
has been completed. ; -
SEPTIC ALTERATION
This structure may be used as a
1133 STATE ROUTE 9
Location -
Owner LA FONTAINE, ROGER & LENA
TAX MAP . NO. 74 . -1-19. 2 By Order of Town Board
TOWN OF. QU N URY
(2 ' - -
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0
TAX MAP. NO. 74.-1-1 9.2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LA, FONTAINE. ROGER & -LENA.
OWNER of property located at 229 ROUTE 9 Street,Road or Ave.
in the Town of Oueensbury,To'Construct or place a REPT= ALTERATI-0N1
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 .
n ROUTE 9 BOX 229
I_ ,,m ,QUEENSBURY;:NY 12804
2. CONTRACTOR or BUILDERS Name
3. CONTRACTOR or BUILDERS Address
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
,SEPT:I.C:;; .:
( )Wood Frame ( I Masonry ( I Steel . ( I
7. PLANS and Specifications
SEPBIC =ALTERATION, AS.PER PLOT PLAN.. SPE.CIFICATION&,:.W�a
8. Proposed Use
SEPTIC:ALTERAT;IO}L
December.
$ 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 Queensbury before the expiration date.) .
.._.,..,.v2.3-..w. .... ., December•Y;,. ..,._ 4 97
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the a Town of Queensbury
Building and. oning Insperxor
Application for SEPTIC DISPOSAL PERMIT .
Town of Queensbury 1
Dept. of Community Development Permit No.9 �/
Building &Codes Office , D o
742 Bay Road Fee Paid $ „ / '
Queensbury, NY 12804 `/ 'f� y
r f
Location of property for installation: 4(,)Y , 1
Property Owner's Name: ge.4.er . L ,L /ti
(/
Property Owner's Mailing Address: ' _`
r
Installer's Name: a. 6.1N,e1 Phone # DEC 1. 81997
1 Pk
Number of bedrooms (if residential): /�/i- Total daily flow: T _
(residential - compute 150 gal./bdrm.)
Topography: /17 flat, rolling, steep slope % of slope
Soil Nature: X sand, loam, clay, other /depth:
Ground water: at what depth? //!- feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: kip-not 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 feet. _
PROPOSED SYSTEM
Septic tank: N-w gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of 7 / size each: 7 ft. by F ft.
Size of stone to be used: # 3 I depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CAlhh1 system and associated electrical work to be inspected by a certified agency.I)
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:
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT -
531 Bay Road
Queensbury NY 12804
51B-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name / `
Locationa f
Date /L Jg '7 Permit # 97-74{2
SOIL TYPE: t-Loam-Clay
Results of Percolation Test- •.
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number- /
Size - ft. x p' ft.
Stone size 3
PIPING: Size Type,
Bldg. to Tank e/!% �Jois
Tank to Dist. Box /" _Jk_
Dist. Box to Field/P' . 'll swe
Openings Sealed? No Partial
LOCATION/SEPARATIO : :
Foundation to Tank ,2O feet
Foundation to Absorption 20 feet
Separation of Pits ,amh-et
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERTY:
(circle o
e
Front - Rear - Left Sid - Rig ide
Middle t - Middle Rear ., AI�W
COMMENTS:
( Q
r fio/l \ :1-
-, t
i -- 4'11/
SYSTEM USE APPROVED: 9 NO ,
Arrived: / 110 .
Departed: '
Dir
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT:
531 Bay Road'
Queensbury NY 12804 . .
51B-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name /(J
Location v` /e'
Date l 2/ 42 Permit # 7-7512
SOIL TYPE: Sand-Loam-Clay-
Results of Perc latio Test-
(if applicab e) Rate- inute/Inch
TYPE OF SYST .
ABSORPTION FIELD. Total Length
Length of each t nch
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Par.tti al
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:
• 4/o ed .
SYSTEM USE APPROVED: . YES NO
Arrived: Cal
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay. Road'
Queensbury NY 12804
518--745-444/
SEPTIC DISPOSAL SYSTEM INSPECTION
Name "Va.�,[
Location , y
Date /2 07 Permit # 97-1472'
SOIL TYPE: Sand-Loam-C
Results of Per olatio Tes
(if applicable) Rate-' inut./Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tol.l L"ngth
Length of each tren 4
Depth of trenches
Size of stone
SEEPAGE PITS: Numbe
Size - ft. x ft.
Stone size
PIPING: Size Type .
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/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:
c —ed)e.;
SYSTEM USE APPROVED: YES NO
Arrived: j,Zo
Departed:
Building
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