98-118 CLIP TIFICXrE OF COMPLIANCE
TOWN OF QUEENSOURY
WARREN COUNTY , NEW YORK
Da Le -Apr l 1 7 19 _ 98
..-
ThiAiso certify th wark requested to be done as Shawn by Permit No . 98118
has been completed .
This structure may be used as a SEPTIC ALTERATION
Location 18 DIVISION RD &
Owner DELONG , RONALD
TAX HEF►F NO . 147 . - 1 - 51 By Order of Town Board
TOWN OF QUEENSBURY
Di �rr 4 eUIT no ode En forcemen t
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBUR.Y No. 98118
TAX NAP NO . 147 . — 1 - 51 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to DELONG r RQUALD
OWNER of property located at 16 DIVISION RD r Street, Road or Ave.
in the Town of Oueensbury, To Construct of 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 Oueensbury Building and Zoning Ordinance.
1. O WNE R'S Address is
1S DIVISION RD .
QUEENSBURY , NY 12804
2. CONTRACTOR or BUILDERS Name
T . B . S . SEPTIC
3_ CONTRACTOR or SU1LDE R'S Address
2 LOWER WARREN STREET
QUEENSBURYr NY 12804
4. ARCHITECTS Name
5. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by XI
SEPTIC
1 I Wood Frame 1 I masonry ( I Steel I Y
7. PLANS and Specifications
SEP"IC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8, Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAIL] — THIS PERMIT EXPIRES April 7 19 2000
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbvry before the expiration date.)
Dated at the Town of Oueensb 7 April ury this Day of 19 19
SIGNED BY " ice � % �� for the Town of Oueensbury
OuIIdIng and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury �-
Dept. of Community Development Permit No.
Building & Codes Office
742 Bay Road Fee Paid $ jam. Q�
Queensbury, NY 12904
/ frrr S j`� A
Location of property for installation:
Property owner's Name:
Property Owner's Mailing Address: d n
Installer' s Name: y �} , ) .,��,L7 %r [, Phone
,� fir; C'+•, r- 401
Number of bedrooms (if residential): Total daily flow:
(residential - compute 150 g )
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other f depth:
Ground water: at what depth?/feet I Bedrock or Impervious Material: at what depth? J feet
Percolation test: not requir , required. [ rate min, per inch ]
Domestic water supply: -X04municipal, well, other
If domestic crater supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank/-6-0.0 gallon (minimum size: 1 ,000 gal.)
Tile field: each trench _.56) feet 1 Total system length: a % 0 e> _ 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: 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 Coda of the Town of Queensbury, any permit or
approval granted which is based upon or is granted in reliance upon any material misrepresentation or fe2ure to make a
material fast or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this apphcautlon and agree to abide by these and all ,;rernents of the Town of
Q eembury Sanitary Sewage Disposal Ch livaancce.Signature of responsible person.: < C.�--< .--�- C Date: f[ter~2 f
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensberry NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location _ rnch�
Date '�-' rPermit #SOIL. TYP - a - oam-Clay-
Results of P rcolation Tes( if applicab e ) Rate-MinutTYPE OF SYS
ABSORPTION F LD : Total Le
Length of eac trench
Depth of tree hes '
Size of stone
SEEPAGE PITS : Number-
Size - ft . x f to
Stone size
PIPING: Size Type
Bldg . to Tank " ��►h 1
Tank to Dist .
Dist . Box to Fie el /P t �' 11�'
Openings Sealed ? a artia
LOCATION/SEPARATI
Foundation to Tan _ feet
Foundation to Ab o tion 'Z� feet
Separation of P is feet
Conforms as pe Plot Plan es
LOCATION OF S STEM PROPE
( circle one )
Front - Rea Side
Middle Fro t - ear
COMMENTS :
SYSTEM USE APPROVED : �E
Arrived :
Departed :
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TOWN AkQQ SDATE
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