96-749 _ r
nr�a a�rn■ o nay wra�c .wv�...�
CLIP TIFICKP E OF COMPLIANCE'
TOWN OF UUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 a�
This is to certify that work requested to be .done as shown by Permit No. 96749
has been completed.
This structure may be used as, a SEPTIC ALTERATION
Location 1 j4A T-ND'LANA AVE .
Owner DEAN, ROBORT L. a SR.
By Order of Town Board
TRIX HAP NO. 127 . -"9-10. 1 TOOW„-OF QUEENSBURY
fi
Director of Building b Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY \ 96749
TAX MAP NO. 127 . -9-10 . 1 No.
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to DEAN, ROBERT L. , SR.
OWNER of property located at 134A INDIANA AVE .
Street, Road or Ave.
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
134A INDIANA AVE.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( 1 Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
SEPW! ALTERATION AS PER PLOT PLAN SPECIFICATIONS '
8. Proposed Use
SEPTIC ALTERATION
25 December 5 98
$ 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.)
5 December 96
Dated at the Town of Qu ry this Day of 19
SIGNED BY for the Town of Queensbury
Building nd Zoning Inspector
� y
Application for SEPTIC DISPOSAL P.�.RMI7' o
.) --
Location of prolierly Irnr ins/ItallaUnn: -- DEC 05 1996
Owncr's Namc S D4,,%j'
y,? ai l UlliLd la s
WING
WC -
Qwncr*s Mailing Address: Z y /q —f--r r Y" (t_//i"
11:1; PAID
Installer's Name: I'honc
Number of bedrooms (if residential):
Total daily flow (residential -cotnliute n) 150 gal. per bedroom).
Topography:` Ihnt�'� 0 Rolling Steep Slolic °b of Slope
Soil Nature: Sand Q [.Darn Q Clay Q Otlier /Depth:
Ground Water: at what depth? feet
Bedrock or Impervious Material: at what depth? reet
Percolation Test: Not Required Q Required/Rate min. 1wr inch
Domestic Water Supply: Municipal Q 'Well Uther
i'
If domestic water supply is a Wi:LL: water supply from any septic absorption is. Cect
PROPOSisD SY517:M:
Septic tank:le!)dn gal, (minimum size: 1.000 gn1.)
'life Field: lcugth feet.
Seepage Pit(s): number oC / size each: ft. x Ct. C9 -
Size or stone to be aced: # - depth or-thickness feet.
It _
1101-DING TANK SYSI'llm: (irrequired)
Number or tanks: Size of each: 66:> gal.
LAiarm system curd associateci electrical work to be inspected by ii certified it eircy.
For yotcr protection, please pore that prirsttctttt to .Section 136-29 of the Cfide ofthe 'I'ort•ti of
Queensbury, any permit or approwil granted which is based upon or isgraitted in.reliance.upon
any material misrepresetrlation or friilrtre to make a material frct or circuntstance kttrrti�n by or on
behalf of an a pplic•aht, shall be void.
I have read the regulations with respect to this application h agree to abide by these and all _.
requirententr of the. Town of Queensbtcry� titary Sewn a Di. osal Ordinance.
Signature of responsib'e person:
�L
2� �
ice'11t
EEN
TOWS ®F O
IEWVEID) lay
PLEV
"I have seen or,observed, or believe I.saw evidence of, �..
all nblects such as houses, wells, trees, fences, etc.,
snown on this document. I a_,:o,represent that I have
Personally measured nantes set forth on the diagram."
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TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name a,4,
Location �le i<
Date j Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Perc lation Test-
(if applicable) e-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION F D: Total Length _
Length of each tr hch
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - _ C�__ ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/P '
Openings Sealed? Y No Partial
LOCATION/SEPARATIO
Foundation to Tank feet
Foundation to Absorption 36 feet
Separation of Pits —:? eet
Conforms as per Plot Plan es ' No
LOCATION OF SYSTEM ON PROPERT
(circle one) fr-
Front - Rear .- Left Sid - Right Side
Middle Front - , ear
COMMENTS:
SYSTEM USE APPROVED: ES NO
Arrived: ( '�
Departed:
(/U-
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date /� i�b Permit # it 7�
SOIL TYPE: Sand-Loam-6 y
Results of Percolation est-
(if applicable) Rate- in-te/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: . Total Length _
Length of each trench
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/P'
Openings Sealed? Yes No Partial
LOCATION/SEPARATION
Foundation to Tank � feet
Foundation to Absorption _ feet
Separation os 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:
61
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building InsP ctor