1999-284 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 27 19 99
99285
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 16 MIDNIGHT DR. SOUTH
Owner SALISBURY, MARY ELLEN
TAX MAP NO. 90 . -4-11 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
-_vp_T r �.., - = TOWN OF QUEENSBURY No. 99285
TAX MAP NO. 90. -4-11 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to SALISBURY, MARY ELLEN
OWNER of property located at 16 MIDNIGHT DR. SOUTH 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
16 MIDNIGHT DR. SOUTH
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDER'S Address
2. LOWER WARREN. STREET
QUEENSBURY., NY 12804
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel ( 1
7. PLANS and Specifications .
No.
8. Proposed Use .
SEPTIC ALTERATION
25 May 26 �9 2001
$ - PERMIT FEE PAID —THIS PERMIT EXPIRES
(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.)
26 May 19 1999
Dated at the Town of Queensbury this Day of
SIGNED BY
for the Town of Queensbury
Building and oning I ctor
ry Application for SEPTIC DISPOSAL PERMIT -
Town of Queensbury i . CI
99285 90 4=11' + '.�PermitNo. .0 -05
Dept. of Community Dz:'' SALI SBURY , MARY ELLEN.. -
Building &Codes Office
742 Bay Road ! i, 16 MIDNIGHT DR'. 'SOUTH `'� ab
Queensbury, NY 12804` $
'.' SEPTIC ALTERATION Fee Paid
E i6
Location of property for installation: xi-a ",-)/f, 4 fr -1t, ,,,( 6 8
MAY 2 199
Property Owner's Name: ,521. ( 5 ofc-- TOWN OF C�UEENSBURY
/ AND CODE
Property Owner's Mailing Address: `,62 ` /1 e 4 % y`r,` BUILDINGv
Installer's Name: i r,/e K. ic-r Phone # ?Pr-to V
_ r/
. Number of bedrooms (if residential): 3 Total daily flow: (f co
(residential -compute @ 150 gal./bdrm.)
Topography: A/flat, rolling, steep slope % of slope
• Soil Nature: sand, loam, clay, other I depth:
_
Ground water: at what depth?M4 feet / Bedrock or Impervious Material: at what depth? — feet
Percolation test:MiL Rot rep i ed, - required [rate min. per Bch I _ _
Domestic water supply: rmunicipal, well, other
If domestic water supply is a WELL,L, water supply from any septic absorption is feet. _
PROPOSED SYSTEM
•
Septic tank®O gallon (minimum size: 1,000 I.)
Tile field: each trench feet / Total system Iengeth: feet
Seepage pit(s): number of ) / size each: _ K ft.by 6V ft.
Size of stone to be used: # `` / depth or tixiclmess 1 feet -
HOLDRVG TANK SYSTEM: (if required)
Number of tanks: : Size of each: gallons
Alarm system and associated electrical woric to be inspected by a certified agency.
J
For your protection, please note that pursuant to Section 136-29 of the Coda of the Town of Qoeeagbury, any permit or
akpluval 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 regtirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance. -
Signature of responsible person: ed"e
Date: ri 6. —py
•
TOWN OF QUEENSBURY ' 0
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name E'2)6\-- S\CUNcU
Location
Date _ —„_ -link Permit # `-a- S
SOIL TYPE'Sand oam-Clay-
Results of Perco ation . est-
(if applicable) 'ate-Mi ute/I ch
TYPE OF SYSTEM,
ABSORPTION FIELD: ..'tal Lengti
Length of each trenc •
Depth of trenches
Size of stone
SEEPAGE Pg Number- .
Size - ft x ft.
c_L
Stone size �j
PIPING: Si Type
Bldg. to Tank
Tank to Dist. Boxy`
Dist. Box to Field/Pit '
Openings Sealed? No Partial
LOCATION/SEPARATION ail.
Foundation to.Tank feet
Foundation to Absorp ion J feet
Separation of Pits feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPER
(circle
Front - 'ea - e - Right Side
Middle Front - Middle Rear
COMMENTS:
•
SYSTEM USE APPROVED: NO
Arrived:
Departed: —d
212Lv
Building Inspector
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