1999-471 CERTIFICATE OF COMPLIANCE.
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date July 29 19 99
3o&. oicj
99471
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 46 BOULEVARD --
Owner SAWYER, RODNEY & ELEANOR
TAX MAP NO. 111 . -3-11 By Order of Town Board '
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No
VALUE.:- $. 0 99471 .
TAX MAP NO. 111 . -3-11 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted.to SAWYFg RODNEY & ELEANOR.
OWNER of property located at 46 BOUT FVARD 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 an other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1.OWNER'S Address is .
46 BOULEVARD
QUEENSBURY, NY. 12804,
2. CONTRACTOR or BUILDERS Name
I.B. S. SEPTIC
3. CONTRACTOR or BUILDERS Address
2 LOWER WARREN STREET. .
QUEENSBURY, NY. ;..12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTA.:ALTERATION AS .PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC. ALTERATION • ..
$ PERMIT FEE PAID -THIS=PERMIT EXPIRES July 30 19 2O 1
(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.6
Dated at the Town of Queensbury this 30 ' Day of` `- `July. ; 19 1999
SIGNED BY ` �--�_'�jeAk8ZA, for the Town of Queensbury
Building.and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of QueensburyQA
Dept. of Community Development Permit No. �J
Building &Codes Office
742 Bay Road Fee Paid $ '°°
Queensbury, NY 12804
Location of property for installation: # q 6�. , � RECEIVED
Property Owner's Name: �� ' c Ste" 9 7999
�OV1l:� Or OfjE�ts�3Ll6ly
Property Owner's Mailing Address:
Li LODE
Installer's Name: I _ /,>. )'(.,Q/ C Phone # 79K7?—
. Number of bedrooms (if residential): 3 Total daily flow: K
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
- Soil Nature: sand, Ioam, clay, other /depth:
Ground water: at what depth? eet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: An-ot required, required [rate min. perch]
Domestic water supply: unicipal, well, other
If domestic water supply is a 177=T T, water supply from any septic absorptions feet.
PROPOSED SYSTEM
• Septic tank`®®®gallon (minimum size: 1,000 gal.)
Tile field: each trench c 0 feet / Total system lens :c)(9e feet
Seepage pit(s): number of / size each: . ft.by ft.
Size of stone to be used: # / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: pans
Alarm system and associated electrical Rork to be inspected by a certified a,mcr.1
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Qoeecsbury, any permit or
approval granted winch is based upon or is granted in reliance upon any material misrepresec n 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 re r..:rements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: � Date: 2'e. d 2 , 99
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TOWNOF QUEENSBURY /)
BUILDING & CODE ENFORCEMENT
--1, l./
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name r -
ll
Location UI—\i' -.
Date 'c, - Permit #99—` .71
SOIL TYPE: and-Loam-Clay-
Results of Percolation est\-
(if applicable) Rate- inute/ nch
TYPE OF SYSTEM: �
Vital
ABSORPTION F' LD: Lei, h
Length of each . en h l '"Depth of trenches
Size of stone
SEEPAGE PITS: Nu ber-
Size - f+. x ft.
Stone size .�
PIPING: Size Type
Bldg. to Tank tL° `a°" -:
Tank to Dist. B•x ik
Dist. Box to Fi�el d/P•■� vt
Openings Sealed?\ Yes No Partial
LOCATION/SEPARATION :
Foundation to Tank 1 (� feet
Foundation to Absorption QO feet
Separation of Pits e:t
"-Conforms as per Plot Plan ' Yes !o
LOCATION OF SYST ROPER Y:
(circle one)
Front - Rear - eft Si e - Right Side
Middle Front - Mi Rear
COMMENTS:
l--=i 6c, .AS g o t l.-r 0 Ai vi LE
SYSTEM USE APPROVED: E NO
Arrived:r : /
Departed• PL
Building Inspector
^-
-- - - - '^ -
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------ "I have seen or observed, or bilievi I-saw evidence of—
all objects such as hobses,-wells;-tree%-fence% etc.,
shown-on-this-document—. -also'reprOsent that-I-have
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TOWN OF QUEENSBURY
/O 7I
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 'R 5. oe4J 7fZ-71412
Location LZQ t av _Le-vg4seb
Date L0/34/19 Permit # i4104i1J6
SOIL TYPE: Sand-Loam-Clay- l°[ OI
Results of Percolation Test-
(if applicable) Rate-Minute/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/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:
C ,K , iM2 '° �v�}rio�J
J5
9-y
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: ' -7
Building Inspector
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