1999-731 • Certificate - ,..-of • Compliance
ToWn of Queensbury
Warren County,New York
November 30 9 9
Date
9 9731
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC SYSTEM
This structure may be used as a
67 BOULEVARD—
Location
• FRANK & JIP-1, INC.
Owner
TAX MAP NO. 112 . -1--70 •
By Order Town Board
TOWN OF QUEEN URY
Director of Building & 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 7 31
TAX MAP NO. 1 1 2 . -1-2 0
FRANK & JIM, INC.
Permission is hereby granted to
67 BOULEVARD
Owner of property located at
in the Town of Queensbury,to construct or place a SEPTIC SYSTEM
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.
53%CV MI
QUEENSBURY, NY 12804
Contractor or Builder's Name:
I .B. S. SEPTIC
Contractor or Builder's Address:
Electrical Inspection Agency:
Type of Construction: SEPTIC
Plans and Specifications:
SEPTIC SYSTEM FOR 3 BEDROOM HOUSE AS PER PLOT PLAN AND. SPECIFICATIONS
Proposed Use:
SEPTIC SYSTEM
2.5 November 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 Enforc,-enient
Officer of the Town of Queensbury before the expiration date.)
29 November 1999
Dated at the ' o Queensbury s's Day of
SIGNED BY ,�A,rdiro <i : the-TM—A of Queensbury
• Enforcemen rag cer
Application for SEPTIC DISPOSAL, PERMIT
Town of Queeasbury• ')
Dept of Community Development ( j` WED
Permit No. i -)1
Building &Codes Office 4 i . 'h-
742 Bay Road �' !�
�J Fee Paid "t
Queensbury, NY 12804 N O V 2 e 1999 So
TOWN OF
•
Location of property for installation` �" (�� t-=071-. , i C
ct,l� L
Property Owner's Name: j+U ;N, r1. gi M TA/ C
Property Owner's Mailing Address:
Installer's Name: !� f ® � G Phone # T)9P+f J?
- Number of bedrooms (if residential):
Total daily flow: vs- p
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: () sand, loam, clay, other /depth:
Ground water: atwhat deptl> t" T feet / Bedrock or Impery feet
ious Material: at what depth?
AA f „
Percolation test:/al not required, required j rate min. per inch] `
Domestic water supply: Kmunicipai, well, other
If domestic water supply is a WELL, water supply from any sepdc absorption is feet.
PROPOSED SYSTEM k�• f
Septic tank:/®Do gallon (minimum size: 1,CCO a.)
Tile field: each tench So feet / Total system length: 4 ® feet
Seepage pit(s): number of / size each: . ft.by, fr.
Size of stone to be used: # / death or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: : Size of eaca: gallons
CAlarm system and associated electrical work to be inspected by a certified a, xy.J
For you:protection, please note that pursuant to Section 136-29 of the Code of the Town of Queeastazy, any pent or
approval garbed which is based upon or is granted is reliance upon a,-y mateZYal misreprese ztcn or failure to make a
material fact or circumstance known by or on behalf of an appLic , Lail 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
Queers;..-y Snnitary Sewage Disposal Ordnance.
Signature of responsible person: Date:4402 I .29
0
TOWN OF QUEENSBURY ( 2pil`
BUILDING & CODE ENFORCEMENT
--'42 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSALS TEM INSPECTION
Name L ( 1/ ._.�P\._c_
Location ; I? e-rz-,e_--'
Date /(4, 9 Permit # 97 /
SOIL TYPE: ' and- oam-Clay��
Results of Percolation Test-
(if applicable') Rate-Mi ni1'te/Inch
TYPE OF SYSTEM:\
ABSORPTION FIELD: Total engtah OO
p
Length of each tr'enchl
Depth of trench - I
Size of stone 32
SEEPAGE PITS: Number-/'
Size - ft. x,, I ft.
Stone size V
PIPING: a, Size Type _
Bldg. to Tank I'{, " Spk 35
Tank to Dist. Box �: .4 ----- ---
Dist. Box to Field/P . 'x ,4 540 l)
Openings Sealed? i Yes'; No Parti a
LOCATION/SEPARATION .
Foundation to Tank'` "rG, ,/ feet
Foundation to Absorption L . feet
Separation of Pins `). eet
Conforms as P a Plot Plan 4j Yes No
LOCATION OF SSTEM ON PROPERTY:
(circle n-m)
Front Rd Left Side - Right Side
Middle Fron - Middle Rear
COMMENTS:
•
if
SYSTEM USE APPROVED: YES NOS,
Arrived:
Departed: C/
Building Inspector
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