95-689 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 13
vecem e . 95
This is to certify that work requested to be done as shown by Permit Ho..9 5�89 ;_
has been completed.
This structure may be used as a S-EPTIC ALTERATION
Location AVIATION RD. ;
Owner SARSUKOFF IVAN & JANE
By Order of Town Board
TAX MAP NO. 82 . -5-19 TOWN OF QUEENSBURY
Director of Building & Code Enforcemen.t
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY 95689
TAX MAP NO. 82 . -5-19 No.
WARREN COUNTY, NEW YORK
BARSUKOFF, IVAN & JANE
PERMISSION is hereby granted to
AVIATION RD.
OWNER of property located at Street, Road or Ave.
SEPTIC ALTERATION
in the Town of Queensbury,To Construct or place a
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
ROCK CITY RD.
HUDSON FALLS, NY 12839
2. CONTRACTOR or BUI LDER'S Name
VOGEL, PAUL
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry 1 I Steel ( )
7. PLANS and Specifications
SEPTIIGC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES December 11 19 97
(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 11 Day of December 19 95
SIGNED BY \_ for the Town of Queensbury
uildmg and Zoning Inspector
Application ror SEPTIC DISPOSAL .-PERMIT
STAMP IMCEIVEI)
�„�7l 0�1 Z� - °
Locillioll of III ollel ly for ill%1:11111tioll:
Owner's Nano.- IMN IT NM%IIl
()wll(!I-*.-; Mailing Addi SN!
s r4lolle: -79
Installer . .. ....
Mint I ier of I led a onm A I eNidt'l It i:l I):
'I'olal unify I I ow (I esi tic I I I in I - U41111111 Ite (lit 150 ga I. Ile I he(Iloolli):
Tollography: 1-171 Nit I ItollillIt J= Steepshille tlr.qlt)llc
soil Nature. Surd l.woll F-1 c.MY Other
Olotilld Willer: lit what dellill'i t
Dediock or Impeivioils Malcli'll: M %vll:ll feet
Pulcointioll Tv%l: Retillilvel pal inch
Domestic Water Supply: Well outer
If domestic water supply is n 'NVI-*A.I.: water supply rtt)lll liny septic nbsurplitm Is feet
lF---------
-LED
Ni M': I DEC 11 1995
O- F CPL Iiii
'life Held: each it each tolal system Iwigth M"m.�At,;"(�O
.03 — Ak;L_,
,9ccl),Igc Ilil(s): 111111111cr of If size clich: ft. x IL
Size of slope to he timcd. 'y depth or thickness Feet.
Number of(:inks: Size ol,ellch: gill.
Alal-In systellp and.cls.wf-itried elecit-ical wot-k to lit, inspected ly), it cet-fific I agillICY.
Pol.yo.it#- 111wfi-clioll, please non., thirr ptit'sittint to Section 130-29 of the Code of the Town of
Qiwetisbui-y, ally pf!lvnit Ill• appl.o.val graitted which is based upon or is graitled in reliancil 111poll
(Itl). 1110.1et-iol nrim-el Pivsvitlatioll or filill"T to make a marethil fiter or circumstance known by ur on
behalfoftin applicallf, shrill be void,
I have 1-call the rel"Illfiliolls Ividl respect to this it pplictifion and agree to abide by them, and till
ve(II(il-ellpents ofthe Tolull of'Orrery.1 111.). Salli ity Seivage Disposal On/I if it if I ce.
SiXII(Iffile oftespoll.W)"t, person:. l / Date: 1:Z,
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
EN�'�� � shown on this document. I also represent that I have
DEC 11 1995 person ly measured the stan:;,se,to th on the diagram."
zV�i.;¢ZE Cz ��2 i� C:.1RY
SIGNATURE DATE
^�J. �
1 ( 0 1-0
DEC 111995
(
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TOW OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location QL
k8, �
Date a ' — Permit #
SOIL TYPE: and Loam-clay-
Results of Percolati T t-
on(if applicable) Rate-Mi to/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tot Length _
Length of each Nr-
enh
Depth of trench
Size of stone
SEEPAGE PITS: N er-
Size - ` ft! x ) ft.
Stone si F i
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
to P`i
Openings Sea ed? Ye No Partial
LOCATION/SE ARATIO
Foundation to Tank �jcl5T1,V& feet
Foundation to Abso tion -Z— feet
Separatio o�= Pits feet
Conforms s per Pl o Plan
a No
LOCATION OF SYSTEM ;ON PROPERT .
(circle
Front -Ca°r - Left Side - Right Side
Middle F' o - Middle Rear
COMMENTS: _
SYSTEM.USE APPROVED: YES) NO
Arrived:
Departed: /
Building Inspector
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name f 5046F'P 111-411)
Location Als4TI y) 9,0
Date Permit # o — 603
SOIL TYPE: an Loam-Clay-
Results of Percolation jest-
(if applicable) Rate-Mi ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Lengt of each trench
Depth f trenches
Size o stone
SEEPAGE S: Numbe -
Size - ft. /'i� ft.
Stone size
PIPING: Size Type
Bldg. to Tank � rZ% �'�
Tank to Dist. x �'�
Dist. Box to F d/Pi t1
Openings Seal d? Yes No Partial
LOCATION/SE RATI S: /
Foundation o Tank / feet
Foundation to Absorp on feet
Separatio of Pits feet
Conforms s per Plot P1 e No
LOCATION OF SYSTEM ON PR PERT
(circle one)
Front - ,Rear - Left SideNR* tMiddle ront - Middle Rea
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
J�C
Building Inspector
TOWN OF QUEEWSBURY,
BUILDING &.CODE ENFORCEMENT
531 Bay Road ,
Queensbury NY 12864
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date /�7�ermit # r
SOIL TYPE: Sand-Loam-Clay-
Results -of Percolation Test-
(if applicable) Rate-Minute%Inch
TYPE OF STEM:
ABSORPTION \hes
Total' /eng'
th
Length of ench
Depth of trSize of stoSEEPAGE PITberSize. - x ft.
Stone size
PIPING: - Size. Type
Bldg. to Tank
Tank to Dist. B x
Dist. Box to F eld/Pi
Openings 'Seal d? Y No Partial
LOCATION/SEP RATIONS:
Foundation o Tank feet
Foundation to Absorption _ feet
Sep arati0 o" Pits feet
Conforms as per Plot Pla Yes No
LOCATION OF SYSTEM ON PR PERTY:
(circle one)
Front - Rear .= Left Side - Right Side
Middle Front - Middle Rear -
COMMENTS:,
� - 1
SYSTEM USE APPROVED: YES N0.
Arrived:
Departed: b
Building Inspector