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CERTIFICATE OF COMPLIANCE
TOWN OF .QUEENSBURY
WARREN COUNTY, NEW YORK
Date (-%6-7/€ 1 1-, 19 9I
- 7613
This is to certify that work requested to be done as shown by Permit No. 91-
has been completed.
This structure may be occupied as a Septic Al tet°dti o
Locatic 1 PALMER DRIVE
Owner Joe Gross -
By Order Town Board 1
TOWN OF QUEENSBURY
Director of Bldg'. & Code Enforcement
BUILDING PERMIT
a
TOWN OF QUEENSBURY No. 91- 9
3
WARREN COUNTY, NEW YORK
0
PERMISSION is hereby granted to Joe Gross
OWNER of property located at Palmer Drive Street,Road or Ave. 1—'
c
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
Same 0
L
2. CONTRACTOR or BUILDER'S Name 0
Fred Smith
798-1836
3. CONTRACTOR or BUILDER'S Address a
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
V
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications
Septic Alteration to include: 1000 gal tank with 250' of Tile Field 0
No. using #2 Stone,12" Thickness as per plot plan specifications
and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 7, 19 93
(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 7th Day of N ember 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning I nspe 9
`!'OWN OF Q ULENS R L Y I J� .7go '
,,�� fOWN OF
s :t• tr,f rOUEENSDf�e.
' .' a; APPLICATION FORiiliF ECEWED
VAV
, s „la : SEPTIC DISPOSAL PERMIT '
BLDG ''i CODE,DEPT.
) Li q ,,I , '02_ :
DATE / `l .
LOCATION OF PROPERTY FOR INSTALLATION / „v� ,
Owner's Name: C,wss Telephone: 179', dI
Address: fa/72eie ,0 1 u<
Installer's Name: J2'O /7i4 Telephone: / Ygt7:3lo
Number of bedrooms (residential only)
Total daily flow (compute (a 150 gal per bedroom) •. 300
Topography: Circle one:\ Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other , /Depth: / Feet
Ground Water: At what depth? i.V Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: not required required rate / min. inch.
Domestic water supply: circle opMunicipal Well Other
If domestic water supply is a ,
Separation: Water supply from septic absorption / J i feet ;
PROPOSED SYSTEM: Septic TankJ4od gal. (minimum size: 1,000 gal.) ,
TILE FIELD: Each Trench 50 feet/Total system length ' O feet
SEEPAGE PIT(S): Number of / Size each feet by _feet '
Size of stone to be used # &/Depth or Thickness f eg• • feet .. '
************************* ,
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I have read the regulation on the reverse side of.this sheet and agree to abide by these,:' ,
and all requirements of the Town of Queensbury Sanitary ez ag Disposal Ordinance
(\. N OP �a. P7D faupy
SIGNATURE OF RESPONSIBLE PERSON: Y�
ii:J it l i'• ;: -, , f L -. DEFT.
DATE: /0l 9/ REVIEWED �%{, ;a�a
OVER 4:Z=_____________
DATE
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TOWN OF QUEENSBILii,
RECEWED
NOV 7 1991
cn rc.,
BLDG. & CODE DEPT.
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