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98-096 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Da te_ An*- 1 l 3 19 gg E � • [� ' L-'4 �i 98096 j This is to certify that work requested to be done as shown by Permit No . f{ has been completed . This structure may be used as a SEPTIC ALTERATION toc a ti on ' [+ zg;F JOHN wT . �~ Owner SPRINGER -CHERNEY , By Order of Town Board TAX MAP NO . 121 . - 1 - 16 . 42 TOWN/OF QUEENS URY Director of Duil i g b Code Enforcement BUILDING PERMIT VALUE $ 0 TOWN OF QUEENSBURY No. 98096 TAX MAP NO . 121 . - 1 - 16 . 42 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to SPRINGER— OWNER of property located at 54 JOHN ST . 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 JACQUELINE BOX 1640 ROUTE 196 HUUSON FALLS , NY 12839 2. CONTRACTOR or BUl L0r5 W3 Name SIMIONEr CHRIS : CONTRACTOR or BUtLDEA'S Address 4. ARCHtTECTS Name 5. ARCHITECT'S Address 6. TYPE of Construction — (Please indicate by X) SEPTIC ( I wood Frame { I Masonry I I Steel I I T. PLANS and Specifications SEPTIQo.ALTERATION AS PER PLOT PLAN SPECIFICATIONS a. Proposed Use SEPTIC ALTERATION 25 'March 31 2000 $ PERMIT FEE PAID — THIS PERMIT EXPIRES 19 (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.l 31 March 19 Dated at the Town of Queensbury this Day of 19 SIGNED BY for the Town of Queensbury Building and zoning Inspector Application for SEPTIC DISPOSAL PERMIT Town of Queensbury / LM Dept_ of Community Development f f lC L) , Permit No. Building & Codes Office 742 Bay Road Fee Paid $ � Queensbury, NY 12804 Location of property for installation: S f Cx' nS�u r �1 Property Owner's Name: Property owner's Mailing Address: Installer's Name: f �.1 l !Aj Prone # Number of bedrooms (if residential): _ > _ Total daily flow: (residential - cornpue 4 ./bdrm. ' ' CIVI p�,� Topography: flat, raking, steep slope % of slope L! Soil Nature: sand, loam, clay, other f depth: MAR 31 1998 Tt74,y � k�RY Ground water: at what depth . 64Teet ,` Bedrock or Impervious Material; Percolation test: '� not required, required [ rate min. per inch ] Domestic water supply: eX' municipal, well, other If domestic water supply is a WELL, water supply from, any septic absorption is feet. PROPOSED SYSTEM Septic tank: _/ ni gallon (numum sine: I ,040 jai.) a sh.px �1 Tile field: each trench feet 1 Total system length: -2.0 4 feet Seepage pit(s) : number of I size each: ft. by ft. Size of stone to be used. #r Z I depth or thickness 1P-6(� feet HOLDING TANK SYSTEM: (iff ,required) Number of tanks: _ h�J 1/1"" Size of each; 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 Queensbury, .any permit or approval granted which is based upon or is granted in reliance upom any material misrepresentation or failure to make a material fact or ciscurnstance known by or on behalf of an applicant, shall be void_ I Have read the regulations with respect to lic agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal ce. Signature of responsible persor'�—� �� Fate: �+'� TOM OF QUEENSBURY BUILDING A CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTIi0N1 Name Location Date - Permit # ,�_� SOIL TY€'CCj:: andy oam- C1 ay- Resu7ts of Perco7ati est- f ( if apjeach R t Mi ute/Inch TYPE O ABSORP : otai Length 7 Length chDepth oSize ofSEEPAGEmber- Size - ftStone s PIPING : Size Type Bldg . to Tanis LhX Tank to Dist . Box � ` ��W:]P� , Dist . Box to Field/Pit is Openings Sealed o a L(ICATIUN SEPARATIONS : Foundation to Tanis feet Foundation to Absorption ; feet Separation of Pits feet Conforms as per Plot Plan ,[�"'�Y �IVP LOCATION OF SYSTEM ON PROPER7`1'"�� ( circle one ) Front - Rear c��.- Right Side Middle From Middle Rear COMMENTS : --- p SYSTEM USE APPROVED: '0 Arrived: a Departed : Bui nspector TOWN OF QUEENSBURY BUILDING g CODE ENFORCEWNT 531 gay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION s / Name .�'1L�, ,c,c Location Date / Permit # SOIL TYPE: Sand- Loam-Clay- Results of Percolation Test. ( if applicable ) Rate- Minute/ Inch TYPE OF SYSTEM: ABSORPTION FIELD. Total L ngth Length of each tr ch Depth of trenches Size of stone SEEPAGE PITS : er- Size - �ft , x ft . ` Stone size PIPING : Sire Type Bldg . to Tank Tank to Dist . Box Dist . Box to Field/Pit Openings Sealed ? Yes Na artTa LO[:ATION/SEPARATIONS : Foundation to Tank feet Foundation to Absorption feet Separation of Pits � feet ConfarTns as per Plot Plan ""-Yes No LOCATION OF SYSTEM ON PROPERTY: ( circle one ) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS : `A SYSTEM USE APPROVED: YES NO Arrived: Departed: Building Inspector TOWN OF QUEENSBUR R BUILDING A CODE ENFORCEMENT 531 Bay Road Queensbury MY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION 11 Name t", :mot c Location •. Date z ,� Permit # SOIL TYPE: Sand- Loam- Clay- Results of Percol tion Test- ( if applicable ) R te- Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD. otal en th Length of each tree h - Depth of trenches Size of stone SEEPAGE PITS : Numbe Size - ft . x ft . Stone Size — PIPING: [ ..._� ..... Bldg , to Tank i e Type Tank to Dist . Box Dist , Box to Fie7d/Pit Openings Sea7ed ? Yes No a�I LOCATION/SEPARATIONS : Foundation to Tank feet Foundation to Absorption feet Separation of pits � feet Conforms as per Plot Plan "des No LOCATION OF :SYSTEM ON PROPERTY: ( circle one ) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS : r SYSTEM USE APPROVED : YES Arrived: .J Dep a r'ted Building Inspectar TOW OF QUEENSBURY BUILDING A cote ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION( Name ` Location � � Date 3a '-q % permit # i SOIL TYPE: Sand- Loam- Clay- Results of Percolation Test- ( if applicable ) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: To 7 Length Length of ea tranc Depth of tr•enc s -- Size Of stone --- --� SEEPAGE PITS : N� -------�_..� Size - ft , ft . Stone Size �- - PIPING : Size ype Bldg : to Tank 'tank to Dist . Box Dist . Box to Field/Pity w- ---- Openings Sealed ? Yes` o a1�'rt LOCATZON/SEPARATIONS : Foundation to Tank Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan feet LOCATION OF SYSTEM ON PROPERTY: s No ( circle one ) f Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS:" 'Of 1DD/ 7 SYSTEM USE APPROVED: YES NO Arrived: r�} Departed: Bui ding pector TOWN OF OPEEMPUPY � i doSul k n RECEIVED �= �. FILE COPY C0flE DES DATE 3