98-293 C.
ERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
�] Uate June 4 19 98
This is to certify that work requested to be done as shown by Permit No . 98293
has been completed .
This structure may be used as a SEPTIC ALTERATION
Location 202 FULLER RD ,
Owner ST . ANDREWS , CHRISTOPHER
By Order of Town Board
TAX MAP NO . 1 23 . - 1 - 14 TOWN OF QUEE 5B Y
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 98293
TAX MAP NO . 123 . - 1 - 14 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to ST * ANDREWS , CHRISTOPHER
OWNER of property located at 202 FULLER RD . Street. Road or Ave.
in the Town of Queensbury. To Construct or place a SEPTIC ALTERATION at the above location in accordance to application together with plot plans and other information hereto tiled and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
f' l O 2 BO233 FULLER RD .
QUEENSSURY , NY 12804
2. CONTRACTOR or SUI LDEWS Name
SANITARY SEWEpR�R
Addross
3,yDntTla a.rRTL1L B_IJIL F(7'BOX 224
kG]�L►lE1NLSlltEFiALiL.(LSS NY 12801
-4. ARCiil i LAM.. !`dam!
5. ARCHITECTS Address
6. TYPE of Construction — 4pi"se indicate by X) SEPTIC
I I Woad Framr f 1 Masonry l l Steer t i
7. PLANS and Specificatiaro
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Na.
n w.w.c..+ tlsa
SEPTIC ALTERATION
25 June 2 2000
S PERMIT FEE PAID - THIS PERMIT 'EXPIRES . 19
of a Ioryer perm is required an application for an extension must be rnadt to the Building and Zoning ina"Ictor of the
town of Ck4wmsbury before the txpifatian date.)
2 June /''� �►
Dated at the Town of Queensbury this Da 19�
SIGNED BY for the Town of Queensbury
BuildingzsndZo i rwpaEtor
_ ,, Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit NO.
Building & Codes office
742 .say Read Fee Paid $ ��
Queembury, NY 12804
�°
Location of property for installation: �'�` A ►;7�� t
Property Owner's Name: S~ c� 7- _ ,4,jz>,,FFwfT JUN (J � l�
Property Owner' Mailing Address: oe)`
Installer's Name: Phone # 7/ 9 d- 7 a S a7
Number of bedrooms (if residential): --- Total daily flaw: D a
,/� (residential - compute 0 150 gal.lbdrm.)
Topography: L flat, roiling, steep slope YO of slope
Soil Nature: said, loam, clay, othA= depth:
Ground water: at what depth? feet I Bedrock or Impervious Material: at what depth? feet
Percolation test: y,' not required', required j 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
Septic tank ` gallon (minimum size: 1,000 gal.)
Tile field: each trench ` feet / Total system length.: ' � � `� feet
Seepage pit(s): number of I I size each: ft. by fL
Size of stone to be used: # / dearth or thickness , feet
--HOLDING TANK SYSTEM: (if required)
Number of tames: Size of eaciL-. ,galloAs
Alarm system mul associated electrical work to be wapected by a cac� agaoicy.
For your pry. Ply note that pummont to Section 136-29 of tbo Code of the Town of Queensbury, my Pew or
approval Wanted toed wJ=h is bared upon or is granted is reliupone upon any material or &aam* to rnaloe a
,material fact or circuinxtance known by or on behalf of an applicznt; shall be void.
I bave read the regulations with respect to and agree+ to abide by dune and all sequ ram ate of the Town of
Qaaeenabury Sanitary Savage 17er7Pcra1 �I !/ Q ��yy
Signature of responsible person: el_ �_ Date` � d-
I e
e
TOWN OF QLfEENSSURY
BUILDING A CODE ENFORCEMENT
742 Say Road
Queensbury NY 12804 -Z��
tsisl 761-8256
s
SEPTIC DISPOSAL SYSTEM INSPECTION
i
Location
Date ermit # "
SOIL TYPE • S - lay"
Results of P rcol ati nneest-
( if applica e ) Rate-Minute/ Inch
TYPE OF SYS
ABSORPTION ELD : Total Length
Length of ea h trench
Depth of tren hes •
Size of stone
SEEPAGE PITS : umber-
Size - to x f
Stone size
PIPING: Size ype
Bldg . to Tank
Tank. to Dist . Box
Dist . Box to Field/ t re 1
Openings Sealed ? s o ar a
LOCATION/SEPARATIONS :
Foundation to Tank feet
Foundation to Absorpti o AWD feet
Separation of Pits
Conforms as per Plot P an o
LOCATION OF SYSTEM ON ROP
( circle one )
Front - Rear - Left id - R ht Side
Middle Front 1 e Ke
COMMENTS :
I
3
i
i
S3
I
i
SYSTEM USE PPROYED : C O
Arrived
Departed : y
� lding n actor
L
C
—-------------
TOWN OF Pw
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B U I I.D A'
P c (13
DATE
JUN 0 1
FILE COPY
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"I have seen or observed, or believe I saw evidence at
all objects such as houses, wells, trees, fiances, etc.,
shown an thi's document I also represent that I have
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ally measu dista set forth on the diagram.T ;7 FK
SIGMA RE DATE