1999-710 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ' November 19 19 99
99710
This is to certify that work requested to be done as shown by Permit No.
has been: completed.
SEPTIC ALTERATION
. This structure may be used as a
Location 5 HEINR.ICK CIRCLE --
Owner SHERRICK, DAVID & LINDA
TAX MAP NO. 90 -4•-34 By Order of Town Board '
TOWN OF-QUEE SBURY
/ a.
Director of Building & Code Enforcement
R �._.._ _ •� - tea—"`
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 99710
TAX MAP NO. 90. -4-34 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to SHERRICK, DAVID & LINDA
OWNER of property located at 5 HEINRICK . CIRCLE 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
5 HEINRICK CIRCLE
QUEENSBURY, NY . 12804
2. CONTRACTOR or BUILDERS Name .
CONDON'S . SEPTIC..&:;DRAIN
3. CONTRACTOR or BUILDERS Address .
0 . . .
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
1 )Wood Frame 1 I Masonry ( I Steel 1 1
7. PLANS and Specifications
SEPT C .ALTERATION- AS PER PLOT PLAN, SPECIFICATIONS
8..Proposed Use
SEPTIC ALTERATION
November 18 2001
$ 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.)
18 November 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
y
Application for SEPTIC DISPOSAL PERMIT
•
Town of Queensbury E
Dept. of Community Development R •C _ \1 F Permit No.
Building &Codes Office 06
742 Bay Road NOV 1 5 1999 Fee Paid l
Queensbury, NY 12804
TOWN OF OUE7 TZDURY
BUILDING AND CODE
Location of property for installation: ' c//f j ( 1 �//�(A'
Property Owner's Name: A v/ ,S 77 E/Q 4(C K •
Property Owner's Mailing Address: a J��//t�A[(' k c (( '
• Installer's Name:arliritIM
Jfi'I DAVAI N) #
. Number of bedrooms (if residential): Li Total daily flow: 66
(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 / Bedrock or Impervious Material: at what depth feet
Percolation test: X not required, required [rate min. per inch]
Domestic water supply: )Y municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM r�
•
Septic tank:! 06 gallon (minimum size: 1,000 gal.)
Tile field: each trench CO feet / Total system length: 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
ll
Alarm system and associated electrical Rork to be inspected by a certified ag xy.J
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Qaeensbury, any permit or
approval granted which is based upon or is granted in reliance upon any material misrepreseon or failure to make a
material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all recuirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance. Jr
Sib ature of responsible person: j(i4' � Date: /( try
ate
TOWN OF QUEENSBURY ✓
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
.
v-e�
Name 5 'mod-r('`G,�
Location <-7
r cc
-F-1Date /04/7 ft ermi t # �(!` 7 0
SOIL TYPE:- and- oam-Clay-
Results of Percola on Test-
(if applicable) Ra e-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Ln t N -'
Length of each tre chl 1
Depth of trerrs.hes
Size of stone r.i...-mik R
SEEPAGE PITS: Nu'ber-
Size - ft. x ft.
Stone size
PIPING: S 'ze Type
Bldg. to Tank >,-7 51)/0-C—
Tank to Dist. Bo ,
Dist. Box to Fie d/Pit
Openings Sealed? e No Partial
LOCATION/SEPARAT ONS: /
Foundation to Ta k / feet
Foundation to Ab orption ?(,) feet
Separation of Pits feet
Conforms as per Plot Plan a No
LOCATION SYSTEM ON PROPERT .
(circle e
Front - a - Left Side - Right Side
Middle Fro - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector
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�999 B .
DATE /(
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"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have
personally measured the distances set forth on the diagram."
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SIGNATURE DATE