98-266 CL+ RTI FICKI.`E 001F COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY . NEW YORK
Date t gLy 20 19 9$—_
98266
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
Location 661 SHERMAN AVE .
Owner CONLEY , J . NORMAN &
By Order of Town Board
TAX MAP NO . 121 . — 3 - 1 . 1 TOWN OF iQUEENSBURY
" - --- - -
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE s e TOWN OF QUEENSBURY No. 98266
TAX MAP NO . 121 . - .3- 1 . 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to CONLEY
(OWNER of property E .located at 661 SHERMAN AV Street, Road or Ave.
in the Town of Queensburya 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.
f. OWNER S Address is
CALISTA L . E . 661 SHERNAN AVE .
QUEENSBURY NY 12804
2. CONTRACTOR or BUI LDER'S Nana
SANITARY SEWER
M CONTRACTOR or BUiLMROS Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
5. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X) SEPTIC
11 Wood Frame 11 Masonry [ I Stael [ I
7. PLANS and Specifications
SEPT?f ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Peoposad v=
SEPTIC ALTERATION
25 May 20 2000
PERMIT FEE PAID - THIS PERMIT EXPIRES t9
$ [if a longer period is required an application for an extension moat be mach to the Building and Zoning inspector of the
town et Queenstwry before %to okpiration date)20 May
Da of 18
Dated at the Town of Queenstxlry this Y for the Town of Queensbury
SIGNED BY
8;U* and Zoni
Application for SEPTIC DISPCISAL PERMIT
Town of Queeasbury Permit No.
Dept, of Community Development
Building & Codes Office Fee Paid $ [K J 4'
400
742 Bay Roast.
Queensbury, NY 12804
Location of property for installation: l V 9 ,1,/r'"`.y"•+y"
Property Owner's Name: t ' �► I t` 't'l i� . c1� t �„+ G e ,r
Property Owner's Mailing Address: 4. 4 *�'+'1 t'/ - •'"f•"g •v /� _
T installer's Name: U 4f 14 �+�� +.sw� Phone #
Number of bedrooms (if residential): Total daily flow:
(residential. - compute 0 150 gal- bdrm•) �y
Topography:
ot--flat, rolling, steep slope `�i of Slope MAY 19 19%
Soil Nature: .jL sand, loam, clay, other ! depth: W-
Ground water: at what depth.? feet ! Bedrock or Impervious Material: at what depth? � feet
Percolation test: ✓iaot required, required [ rate mixt_ per mach �
Domestic water supply: _ municipal, well, other
If domestic water supply is a WHLL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tare oa•Z) gallon (minimum Size: 1,000 gal_)
Tile field: each trench 2, feet I Total system length: ' '� 2- feet
Seepage git(s): number of / size each: ft. by fL
Size of stone to be used: # ! depth or thickness _ feet
HOLDING TANK. SYSTEM: (if required)
Number of tanks: Size of each: gins
Alarta system sad aueocmwd etectricaX vA=k to be impecaed by a vertbHe+d aSeocye
or
For your , please now that yurwmc t to Sec fim 13&29 of the Code of the Tows of Queensbtay, =Y permit
appwval granted wbkh is based upcm or is ,gravead ins reLwance upon snY material or fect7tue 6o tnadoe a
material fsct or fiance k=wrn by or an behalf of an agaplic,mt; shall be void.
I have read the regulabo+as with respect to dtie appliu aton and agree to abide by these and an toqurseamnts of the Tows of
QuiseatsbnrY 3aaaitsa7
ge Sewa i
Signature of responsible person: Dam: 9 99P
TORN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Say Road
Queensbury NY 12W4
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name jr t) r- owe-'. C %f4
Location A t +�'I11
Date Z° 9X" Permit # �
SOIL TYp&:::P �oam-C1 ay-
Results of Percolation Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION F LD : Tota Len th
Length of ea c trenc
Depth of trench s
Size of stone
SEEPAGE PITS : Num r-
Size - ft . x ft .
Stone size
PIPING: Size ype
Bldg , to Tank
Tank. to Dist . B +-► •' P
Dist . Box to Fi 1 d/Pi t +# +• `tea
Openings Sealed ? c�;� No arti a
LOCATION/SEPARATIONS :
Foundation to Tank %.kE�t._ feet
Foundation to Absorption feet
Separation of Pits .ram t
Conforms as per Plot Plan Ye a
LOCATION OF SYSTEM ON PROPERTY :
( circle one ) - 9�t Side
Front - Rear - Leftide �-�'
Middle F ron
COMMENTS :
NT �
SYSTEM USE APPROVED : - K -
Arrived :
Departed -
B zng c or
i
MAY 19 19M �
I
a
i
7rr-
��
r
M
I 00
TOWN F QUEU. IlY
BU YLD b �� �Ii r p .a : iM .
REVIEWED BY 411 have sE'GR or obse or 661w"y all objects such as holut se4 ! er�c,+e of,
HATE sh wry oe this docue . t
Pe !ly measured
t do t that 1 ho"
SIGNA E