1999-677 . .
• . _ .
Certificate of • Compliance
Town of Queensbury
Warren County,New York
October 29 99
Date . •
•
99677
This is to certify that work requested to be done as shown by Pennit No.
has been completed.
SEPTIC ALTERATION
This structure may be used as a •
11 SHERATON LANE SOUTH
Location
SP IELBERGER, MICHAEL &
Owner
TAX MAP NO. 56 -5-9
By Order Town Board
TQWN-OF QUEENSB RY •
•
Director of Buildin & Code Enforcement
• . .
. BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
VALUE $ 0 Building Permit No. 9 9 6 7 7
TAX MAP NO. 5 6 . -5-9
SPIELBERGER, MICHAEL &
Permission is hereby granted to
11 SHERATON LANE SOUTH
Owner of property located at
SEPTIC ALTERATION
in the Town of Queensbury,to construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning ordinance.
JAq's-If-effIERATON LANE SOUTH
QUEENSBURY, NY 12804
Contractor or Builder's Name:
I .B.S. SEPTIC
Contractor or Builder's Address:
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
• Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS .
Proposed Use:
SEPTIC ALTERATION
25 October 29 2001.
$ PERMIT FEE PAID-THIS PERMIT EXPIRES
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
29 October 1999
Dated at the To of Queensbury 's Day of
SIGNED B - for the Town of Queensbury
Code Enforcement cer
Application for SEPTIC DISPOSAL, PERMIT •
Town of Queensbury No.99 /
_ (0�
• Dept. of Community Development RECEIVED
Permit
Building &Codes Office _
742 Bay Road OD
Fee Paid SaS
Queersbury, NY 12804 OCT 2 7 1999
TOVtINOFc)EUEEP SDURY _/ ---
P P k'Ll!f �U P,f p y'
L ocaton of roenY for installation'�-� i.. ,.
•
Property Owner's Name: lY J ,' . G� c', ( lc, [j�r C_`
Property Owner's Mailing Address: S/ri^ram /d iv I �v1.,-./Z1
Installers Name:
' j . //� S< �,/'f l � Phone # 7Y,�-- �'iQ
i
- Number of bedrooms (if residential): ( Total daily flow: •
(residential - compute @ 150 gal./bdrrn.)
Topography: , rolling, steep slope % of sloes
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth?4 eet / Bedrock or Impervious Material: at what depth? feet
Percolation test: knot required, rec [rto min. per:n ch]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
• L krsi
Septic tank gallon (minimum size: 1,000 al.)
Tile field: each wench () feet / Total system length{ $v feet
Seepage pit(s): number of / size each: . ft.by ft.
Size of stone to be used: ;r / death or thickness feet •
HOLDING TANK SYSTEM: (if required)
Number of tanks: : Size of each: aeons
Alarm system and associated electrical work to be inspected by a certified ay.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Qreensbury, any pew or
app.uva1 wed which is based ulx'n or is granted in reliance uz any in rial nrsreprsse en or failure to,..eke a
material fact or cirotnostance known by or on behhtf of an applicT*•±, 0-a1I be void.
I have read the regulations with respect to this application and agree to abide by these ard aII;remedy of the Town of
Queecsb "y Sanitary SAW'age Disposal OIr aIIG.
Sim at ure of responsible person: g,./1/11/_ Date: �� )—,1.
1111 f
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name \c\c\ c_i_%ozQQS, _:";q
Location ) CiN,o S._\(;)-)
Date r) - Permit # 99—ln4
SOIL TYPE C Sancoam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length ' ;1r
Length of each tr- ch 5"o. 50
Depth of trenche
Size of stone
SEEPAGE PITS: Nu ber
Size - ft x . ft.
Stone size
PIPING: Size Type
Bldg. to Tank — a
Tank to Dist. Box V
Dist. Box to Fi el d7Pi i--�►.�Openings Sealed? Ye- No . Partial
LOCATION/SEPARATIONS:
Foundation to Tank ey feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan 41 No
LOCATION OF SYSTEM ON PROPERT •,
( 'rcle one)
4110 :- ;ear - Left Side c3ight Side
e =ron - Middle Rear
COMM' :
SYSTEM USE APPROVED- 4111M NO
Arrived:
Depa ed: '
A(/JA
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