98-222 CLIP TIFIC rl`E OF COMPLIANCE
TOWN Or, QUEENSBURY
WARREN COUNTY , NEW YORK
{ Da to May l3 19 98
3ED • )� "' 98222
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 �W
Location 25 FOREST LANE
Owner CLOUTIER , MARC & MARY
By Order of Town Board
TAX MAP NQ . 122 . - 2 - 9 TOWN OF QUEENSBURY
Director of Building 8 Code Enforcement
}
BUILDING PERMIT
VALUE S TOWN OF QUEENSBURY No. 98222
TAX MAP NO . 122 . - 2 - 4 WARREN COUNTY, NEW YORK
PERMISSION! is hereby granted to CLOUTIER r MARC & MARY
OWNER of property located at 25 FOREST LANE 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 Oueensbury Building and Zoning Ordinance.
t. OWNER'S Address is
25 FOREST LANE
QUEENSHURYr N . Y . 12804
2, CONTRACTOR or BUtLOERS Name
CONDON SEPTIC & DRAIN SERVICE
3. CONTRACTOR or BUILDERS Address
4, ARCHITECT'S Narne
S. ARCHITECTM Address
6. TYPE of Construction — (Please indicate by X) SEPTIC
} Wood Frame ( } Masonry f I Steel f f
7. PLANS and Specifications
SEPTXP ALTERATION AS PER PLOT PLAN SPECIFICATIONS
a. Proposed Use
SEPTIC ALTERATION
25 May 12 2000
PERMIT FEE PAID - THIS PERMIT EXPIRES 19
(If a "or period is reclu*ad an application for an extension must be trade to the swilling and Zoning inspector of the
town of Clueensbury before ttte expiration date.(
12 May 19
Dated at the Town of Oueensbury this Day of 19
SIGNED By for the Town of Oueeosbury
iWirsp and Zonino 1 coon
�►' Application for SEPTIC DISPOSAL PERMIT
Town of Qury �
Dept. of Community Development Permit NO.
Building & Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: z � Fk' ,JQ ecs 4 k4lyeq
Property Owner's Name: C 0 / MAY 05 y IM
Property Owner's Mailing Address:
Installer's Name:Gab6lif K _ %yt /4 fiV Phone # _. . .
Number of bedrooms (if residential): Total daily flow: +'t 21
(residential - compute. 0 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, (floam, clay, other / depth: ,, /
Ground water: at what depth?Y feet f Bedrock or impervious Material: at what depth`? '/�.feet
Percolation test: not required, required [ rate min, per inch. j
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is 1646 feet.
�P
PROPOSED SYSTEM k
Septic tank: Ito' gallco-nT(minimum size: 1 ,000 gal..)
Tile field: each trench �fW feet 1 Total system length: d'61 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
Alarm system and associated electrical work fQ be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of the Coda of the Town of Queensbury, any permit or
approval granted which is based upon or is granted in reliance upon any material miarepresentation or failure to make a
.material fact or circumstance ]mown 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 requirements of the Town of
Queembury Sanitary Sewage Disposal Ordinance-
c
Signature of responsible person: f�.�� ,may _ Date: _ J
I
♦ r �T
TOW OF 4UEEMSBURY
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12w4
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name elo6f ' V-,
Location
C
Date Permit 0 t! -
SOIL TYPE: Sand- loam-Clay-
Results of Percolation Test-
{ if appliytr
inute/inch
TYPE OF S
ABSORPTION MET Length
Length ofdepth of Size pf sSEEPAGE PISize - ft .
Stone sizePIPING: Size hype
Bldg . to Tank
Tank to Dist . Box ► '�
Dist . Box to Field/pit'.,� .� �V
Openings Sealed ? NO artia
LOCATION/SEPARATIONS :
Foundation to Tank E feet
Foundation to Absorption _ ? D feet
Separation of Pits -- feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERTY: "
( circle one )
Front - Reart���_ Right Side
Middle Front - Tfl- R
COMMENTS :
SYSTEM USE APPROVED : - ' no
Arrived:
Depa
u nsp r
j have seen or �—
!! oltl,)cts , observed 1 ldq
slro �rrelr as ho , er hel+ev
acesan3
wry ors tfras t(Qetr�� s , wells e t sa evirtenee
rra!!y mea Er►t t
trees of t�
sand fh Quo r ' fer yes, efc,,
t e distarJee$Desert f f at f h4�
effort err the dra NlV1C}1
$1�NATta�E gr4�'" �
ATE
8661
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