98-175 Y�Vrt
CLIP TI FIC. . rE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Date &prf 1 23 19 _ 98
µ 98175
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 57 MICHIGAN AVE .
Owner DAV I S . J'AMES & EVELYN
i
By Order of Town Board
TAX MAP NO 127 . - 2 - 5 TOWN OF Q E BURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No, 98175
TAX MAP NO . 127 . - 2 - 5 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to DAVIS r .7AMucc E�1ET-Y1
OWNER of property located at 57 MICHIG AVE - Street. Road or Ave.
in the Town of Queensbury, To Construct or place a C T . AT6rrrRATTQW
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
57 MICHIGAN A.VE .
QUEENSSURYr MY 12804
2. CONTRACTOR or BUtt-DEWS Name
QUEENSSURY SEVER
a CONTRACTOR ear BUtL0ER'S Address
JAY SWEET
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Constructtnn — (Ptease Indicate by XI
SEPTIC
I ) wood Frame I I Masonry I ) steel ; l
7. PLANS aril Specifications
SE ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$. proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID THIS PERMIT EXPIRES April 23 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 Clueensbury before the expiration date.)
Gated at the Town of Queensbury this 23
bay of Ap r 1 1 79 19
SIGNED BY ?Cdi - -for the Town of QueensburyBuilding grid Zamnp inspector
Application for SEPTIC DISPOSAL PERMIT
Town of QUeensbury
Dept. of Community Development Permit No.
Building & Codes office
742 Bay Road Fee Paid
Queensbury, NY 12804
Location of property for installation: / hl t C,
Property Owner's Name: , y,. 7 . l� � � , , C APR 22
IM
Property Owner's Mailing Address: 6r�
�R ti' 1 $t7�clii
Installer's Name: Q Phone # � - � k
Number of bedrooms (if residential) : 2 Total daily flow:
(residential - compute 0 150 gal.Ibdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other I depth:
Ground water: at what depth? feet / Bedrock or Impervious :Material: at what depth? . feet
Percolation test: X 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;/ts�'r.J gallon (minimum size: 1 ,000 gal.)
Tile field: each trench Sr feet / Total system length: /� -Sf feet
Seepage pit(s): number of 1 size each: ft by ft.
Size of stone to be used: depth or thickness I'd r` feet
FOLDING TANI K SYSTE2VI: (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 136-2.9 of the Code of the Town of Queensbury, any permit or
approval tented which is }used upon or is tented 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 react the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal
Signature of responsible person: rx }£R Date: -,.-
TOM OF QUEENSSURY
BUILDING & CODE ENFORCENENT
742 Say Road
Queensbury NY IM04
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location _
Date -- Permit
SOIL TY Sand oam-Clay-
Resu s of Percolation Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Total Len hi
Length of each trencir
Depth of trenches cf"
Size of stone
SEEPA PITS : Number- ft .
Size _ t . x
ilk
Stone si a PIPING : S Sze ype
Bldg . to T
Tank to Di s Box
S3i st . Sox el d/ "
Openings aled . Yes No artla
LOCATI EPARATION - C
feet
Found on to Tank feet
Fou ation to Absorption feet
arati on of Pits e No
Conforms as per Plot Plan
LOCATION OF SYSTEM PROPER
( circle one )
Front - Rear - ft $ de - Right Side
Middle Front - Mi a Rear
COMMENTS .
SYSTEM USE APPROVED : YES NO
Arrived : -
Departed :
Building nspe r
owe r.
hate so" or IM
all objects suchr %mom ■sft �« T f etc..
3 Stec Mprownt that t have
shown vnthW � set forth on the diagram
412
DATE.
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IDSY v5 f
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DATE
5_ FILE p y
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Jk
OF QUEENMURY eu#t M DEPAM�"' - gel 60
Based on our limited U&MMat .c"pu y
not beoMusbuW as inftou" the [�p� LIP
e t
s �115 and SOSdftMftft
6M In full
f ippinQl1811CC W" the CodO• � � 7 ^ {7
I rf SIEls
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