95-216 (2) , CERTIFIC, TE OF COMPLIANCE
TOWN OF .Q`UEENSBURY
WARREN, COUNTY, NEW. YORK
• Date Septembel: 25 '19 96
95216
•Thi s is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be, used as a SEPTIC SYSTEM
Location , •
By Order of Town Board
• A .tiTAP go` 1 6 ' 7 1-t;r TOWN. OF QUEENSBURY
'0/ f
94 .7
Director of Building & Code Enforcement
Y BUILDING" PERMIT
VALUE $ 0 'TOWN OF. - QUE-ENSBURY= - rr::,h: .._.:::-.. 95216 :
TAX MAP NO. 16. —1-17- .r No.
WARREN COUNTY, NEW YORK
GREENE, ELEANOR M.
PERMISSION is hereby granted to
73 SEELEY RD.
OWNER of property Iocated,at Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC SYSTEM -_
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
BOX. 73., •
. . ;.
4 CLEVERDALE N:Y =-12820,
2. CONTRACTOR or BUILDER'S Name
ROULIER, JOE
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications •
SEPT Ie•SYSTEM TO INCLUDE: 1250 GAL. TANK US;ING.> -300'
. . FIELD—AS,==P-ER..PLO.T..-_PLAN SPECIFICATIONS=:,,.-_
8. Proposed Use
SEPTIC. SYSTEM _. . - - - i
. -
-
(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 _ f D'ay of 19
SIGNED BY for the Town of Queensbury
Building and Zoning In :ctor
nplication for -
t; S E PTIC DISPOSAL PERMIT STAMP RF3C11 VFD
Location of property for,Jnstallation: ...5-ez , / &,,,,iCc. ,,,./
PFRMI'1'NUMIIEIi
Owner's Name:. o--s ��e�� " ,;«�
Address: A-t s1 , 1:77-,« — rf e'.0 3 35-e
-
�.a,,ote... '1 ' s-.4ol"n/. s��.? D3.2e3
Installer's Name: . �,,"Gc. r ' FEI PAID 45 00
Phone #: ( ) 4 J'e••- ..34-5'Y
Number of bedrooms (if residential): 7 /1p/ , 1 ' r ' 7
Total daily Bow (residential -compute @ 150 gal. per bedroom):
Ge-a-
Topography: [ Flat ri Rolling I I Steep Slope % of Slope
Soil Nature: I Y I Sand n Loam I Clay Other /Depth:
f
Ground Water: at what depth? lS feet •
Bedrock or Impervious Material: at what depth? N� feet
Percolation Test: r1 Not Required r, Required/Rate min. per inch Dome � �
stic Water Supply: I-1 Municipal � Well 1 Other .4pe,c 4-//��
�-7 c-
if domestic water supply is a WELL: water supply from any septic absorption is feet
PROPOSED SYSTEM: -
Septic lank:/•13 c gal. (minimum size: .1.000 gal.)
Tile Field: each trench e 4 feet. / total system length -J feet.
Seepage Pit(s): number of / size each: ft. x ft RECEI\i „
Size of stone to be used: # MAYf
/ depth or thickness feet. 0 51995
IiOLDING 'TANK SYSTEM: (if required) TOWN OFQUEENSBURy
BUILDING AND CODE
Number of tanks: Size of each: gal.
11 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.
1 have read the regulations with respect to this application and agree to abide by these and all
requirements of the Town o f Queensbury Sanitary Sewage Disposal Ordinance. -
Sienattrre o f responsible pets _ -- Date: .S� �s 5 i
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury WY 12804
518-745-4447 .
SEPTIC DISPOSAL SYSTEM INSPECTION ,
Name �I
Location
Date ,
Permit -_
SOIL TYP : Sand-Loam-Cla -
Results of Per olation est-
(if applicable Rate-Mi ute/Inch
TYPE OF SYSTEM
ABSORPTION FIEL : Total Length
Length of each rench
Depth of trenche
Size of stone
SEEPAGE PITS: Nu ber-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/P
Openings Sealed? es No Partial
LOCATION/SEPARATION :
Foundation to Tank ' feet
Foundation to Abso ption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYS ON P'OPERTY:
(circle on-
Front - 'ear - Le t Side Right Side
Middle Front - Middle Rea
COMMENTS:
/790-vreat
•
;1
/Orel 4- Q r/-ed,---I:\of
SYSTEM USE APPROVED: 4:10 NO
Arrived:
Departed:
Building In ector
O E (518)656-3544
JR0uLI ER, INC. BOX 301,CLEVERDALE,N.Y.12820
�s �p '°' (72,........
� •" TOWN OF QUEENSBURY BUILDING DEPARTMENT
Nei
�G-s ,,,,�.��., .so„� Based on our limited examination,
f 7 — compliance with our comments shall
6 - ` '--� - -.•a .o 1•-
not be construed as indicating the
plans and specifications are in full
,“/ -r.07c., compliance with the code.
N Aco '
:I,
a
\
'7a L
�-�d4 o60 TOWN OF JQNpUY
L„OTP PIPE "16$ o 13'.I'ILD N
of2 AAA tit o evl v 'Fear A6C RE 1EWE® B
DATE �,gf��'/
f
.v / 20
RECEIVED
MAY 0 51995 ,
TOWN OF QUEENSBURY ++ ., �.r r� ..
BUILDING AND CODE .. - -
F1E COPY ^ - ,)----' ..., J 5--/
, ;