98-679 CERTIFICATE OF COMPLIANCE
.TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
bate October 29 1% 98
98679
This is to certify that work requested to be done as shown by Permit No.has been completed.
SEPTIC ALTERATION
This structure may be used as a
Location ill AVIATION RD.
BARSUKOFF, IVAN & JANE
Owner
By Order of Town Board
TAX MAP NO. 32 . -5-19
TOWN F q
. Director of Building A Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF . QUEENSBURY No 98679
TAX MAP NO. 82. -5-19 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BARSUKOFF, IVAN & JANE
OWNER of property located at 111 AVIATION RD-. 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.
t. OWNER'S Address is
82 ROCK CITY RD.
HUDSON FALLS, NY 12839-
2. CONTRACTOR or BUILDERS Name
THREW,JEFF
3. CONTRACTOR or BUILDERS Address
21 EAGAN ROAD MOBILE#796-6005
QUEENSBURY, .NY 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by XI
SEPTIC-
( 1 Wood Frame 1 1 Masonry ( 1 Steel 1 I
7. PLANS and Specifications
SEPT:�C .ALTERATION AS PER PLOT PLAN SPECIFICATIONS. .
S. Proposed Use
SEPTIC ALTERATION
25. October 27 2000
$ PERMIT FEE PAID-THIS PERMIT EXPIRES 19
(If a longer period is requiied an ipplication for an extension must be made.t'o the Buildup and Zoning inspector of the
town of f]ueensbury before the expiration date.) .
27 October. 1998
Dated at the Town of Queensbury his Day of 19
SIGNED BY x W for the Town of Queensbury
Building and Zoning.Inspector
i
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Dept. of Community Development Permit No. _
29
Building &Codes Office C7-0
742 Bay Road Fee Paid $
Queensbury, N1Y 12804
Location of property for installation: (plf- ,(�
Property Owner's Name: J LfA
Property Owner's Mailing Address: Z
OV
Installer's Name: (. l„,?P,u-! Phone #
Number of bedrooms (if residential): 2 Total daily flow: OCTJ� 1999
(residential - compute @ 150-4al./bdrm:)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: Vmunicipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTE
Septic tank: _ gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of l / size each: . ft. by /v ft.
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: 44,arn gallons
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 Queens bury, 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 Oni$ance.
Sib ature of responsible person: / j a441 Date: i 0--Z7��
1�
i
U
1 J
r Ocra,7 1998
0
1--� IP -
'�It IM or observed. or Wieve I saw evade!!
oft such as houses, :v{etl{ , trees, fences, etc.,
a s loft document. 3 aiso represent that I have
pei red the dista es set forth on the diagrami."
c p iUR
7 0����5' 'U'll O p;
U Ltry.i
a
DATE
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name }�'�C/tlCdA��
Location Mj cXV L�
Date Oa Permi t # ---67
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTE
ABSORPTION FI D: Total Length
Length of each trench
Depth of trench
Size of stone
SEEPAGE PITS- Numbe -
,Size - / ft. x ft.
Stone,-'size
PI/PING: 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:
ve-
I�tA)
156-6- d // 1511 oe9
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector
TOM OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name A ) Ckf N'
Location
Date Permit #
SOIL TYPE Sand- oam-Clay-
Results of ercolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE P TS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank t Dist. Box
Dist Bo to Field/Pit �,c b P
Openings led? ( ee N Partial
LOCATIOH1/SEP IONSf
Foundatio n feet
ation to Absorption feet
Separation of Pits %— feet
Conforms as per Plot P1 an e' No
LOCATION OF SYSTEM ON PROPERT
(circle one)
Front - Rea Left Sid - Right Sid
Middle Front - Middle Re
COMMENTS:
0`� t
SYSTEM USE APPROVED: (YES) NO
Arrived:
Departed:
Building Inspector