1999-635 CERTIFICATE OF COMPLIANCE
:TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 6 19 99
'99635
This is to certify that work requested to be done as shown by.Permit No.
has been completed.
This "structure may be used as a SEPTIC ALTERATION
location 220. SHERMAN AVENUE ---
Owner LENNOX, RUTH
TAX MAP NO. 117. -1-6 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement. .
-.�
BUILDING PERMIT
TOWN 'OF QUEENSBURY
99635
TAX MAP NO. 117 . —1-6 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LENNOX, RUTH
OWNER of property located-at GI SHWIRDIAN_A.v.r44.u.F Street,Road or Ave.
in the Town of Oueensbury,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
220 SHERMAN AVENUE
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Nam*
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
JAY, SWEET
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( I Wood Frame ( I Masonry ( I Steel ( )
7. PLANS and Specifications
SEPT X(C ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
2001
PERMIT FEE PAID —THIS PERMIT EXPIRES October 4 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 Oueensbury before the expiration date.1
4 October 1999
Dated at the Town of Oueensbury this Day of 19
SIGNED BY Cert)e.-- III1for the Town of Oueensbury
Build rig and Zoning Inspector ,
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Permit No. �� �
Dept. of Community Development
Building &Codes Office I / O 0
' — (
742 Bay Road i4) Fee Paid $
Queensbury, NY 12804
} frt., s ��
Location of property for installation: Ot v W�-4 ,!� �'�1�—
OCT 0 4 1999
Property Owner's Name: kct �' P 1�J{'l�`1 X TOWN OF 0.ricN;:B;1RY
F3UI�C�ilrl� <+'i�U 00t��
Property Owner's Mailing Address: c2g6 Sj Le r frn a) 61 e sk( V
Installer's Name: p�i�S�,Zc ,� J��� � Phone # 7 f 21i 51 6(
. Number of bedrooms (if residential): 2 Total daily flow: Cr?)
(residential - compute @ 150 gal./bdrm.)
Topography: )( flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
• Ground water: at what depth? feet / BPArock or Impervious Material: at what depth? feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: X municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank.`/d d gallon (minimum size: 1,000 gal.)
Tile field: each trench ifd feet / Total system length: ( feet
Seepage pit(s): number of / size each: - ft. by ft.
Size of stone to be used: # I depth or thickness 1 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 Code of the Town of Queensbury, any permit or
app uval 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 beh df of an applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance,
Signature of responsible person: Date: 0 C / 7
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 .Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Na 4 4 n tk,, 26.1rjo
Lo ati on ���� �
Date i� OC Permit # ( 24 3
SOIL TYP . Sang asm-Clay-
Results of Percol ion Test-
(if applicable) te- 'nute/Inch
TYPE OF SYSTEM:
ABSORPTION FIE : T,•tal Length \V,
Length of each trench � lc)` z_ VOZt
Depth of t hes L.Dcleu
Size of stone ]
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to T nk 4-4 " �t'SD23�
Tank to Di t. Box NC
Dist. Box to Field/Pit 444 o&_. paQ-
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank \ c) feet
Foundation to Absorption 7 c feet
Separation of Pits feet
Conforms as per Plot Plan gillboNo
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Fron . i is e 'ear
COMMENTS:
36?-Lb
•
SYSTEM USE APPROVED: YES NO
Arrived:- 1
Dep ed: /
uilding ns, - ''or
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6
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gym.\\ c ri.Int( . FILE
REcENHD
OCT 0 4 1999
TO
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"I have seen or observed, or believe I saw evidence of,
all cbjects such as houses, wells, trees, fences, etc., •
shown on this document. I also represent that I have .
per ally measured the di ances se forth on the diagram."
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SI NATURE DATE . .-. ��. °t-J _
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