98-252 CL.RTI FICNrE 010 COMPLIANCE
TOWN OF QUEENSSURY
WARREN COUNTY , NEW YORK
Date ._. . May 21 19 98
98252
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 SrEPTId ALTERATION
Location 15 BELLEWS CIRCLE
Owner CRAMS , PATRICIA
By Order of Town Board
TAX MAP NO . 12 1 . - 1 - 5 3 . 1 5 2 . T OWN OFF QUEF SB RY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 98252
TAX MAP NO . 121 . - 1 - 53 . 152IHARREN COUNTY, NEW YORK
PERMISSION is hereby granted to CRANS r PATRICIA
OWNER of property located at 15 BELLEWS CIRCLE Street, Road or Ave.
To Construct or place a SEPTIC ALTERATION
in the Town of Queertsbury, V
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.
t' IV'We� CIRCLE
QUEENSBURYr NY 12804
2. CONTRACTOR or BUILVER"S Name
SIGNORELLI & SON
a SWR 0MW MW IV AD
QUEENSBURYF NY 12804
4." AR%iiii= T a Name
S. ARCHITECT'S Address
6. TYPE of Construction — (Plsase indicate by X) SEPTIC
I I wood Frame l l 06usonry 1 1 Steel l I
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
No.
1 i� Yam+
O. r arynr
SEPTIC ALTERATION
May 15 2000
S PERMIT FEE PAID - THIS PERMIT EXPIRES 19
lit a longer period is required an application lot an extension must be made to the Building and Zoning inspector of the
town of Queensbury before this eepiration detag May 19
Dated at the Town of Queensbury this }1 Day of 0 jlg
SIGNED BY for the Town of Queensbury
Building and Zoning I
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit Nos
Dept. of Community Development
Building & Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: / / D 10
Property Owner's Name: ,.�
Property Owner's Mailing Address: 1S �'1fC3cc 1 S C. 14eG'l' - - -- —: _
g ,
Installer's Name: �^l� t4 Na g eC �1 _ Phone # W1 Ay
�`
Number of bedrooms (if residential) : Total daily flow:
(residential - compute a -T50 gal/bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other f depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? . feet
Percolation test: not required, required [ rate min. per inch I
Domestic water supply: 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.) r� �,�
Tile field: each trench ...�'9 feet 1 Total system length: C2�" " feet
Seepage pits): 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 to be inspected by a certified agency.
For your protection, please now that pursuartk to Section 136-29 of the Code of the Town of Queembury, any permit or
approval granted which is based upon or is granted in relic ice ti any material misrepresentation or failure to :Hake 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
Queensbury Sanitary Sewage Disposal Ordwance.
Signature of responsible person: Date:
TOWN OF QUEENSBURY
BUILDING CODE ENFORCEMENT
742 Say Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name t M� �+A►-�
Location -L ► • 1 C~ '1 ttQ
[late 3 .7 1-'9B Permit #��
SOIL TYPE San - oam- Clay-
Resul is of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM: %
ABSORPTION FIELD : Total Length _
Length of each trench � 1tc' Q
Depth of trenches
Size of stone � 2
SEEPAGE PITS : umber-
Size - t '
Stone size
PIPING : Size ype
Bldg . to -
j Tank. to Dist . ox
Dist . Sox to F el d/Pit
Openings Seale Yes o artia
LOCATION/SEPARATIONS : feet
Foundation to Tank
Foundation to Absorption feet
Separation of Pits
Conforms as per Plot Plan o
LOCATION OF SYSTEM ON PROPER
( circle one)
Front - Rear - Left Side - Right Side
Middle Front
COMMENTS . --�
SYSTEM USE APPROVED : ES -� MO
Arrived :
Departed ' •. ' -
g ns r
TOWN OF QUEENSBURY PF) em pWL_
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location _ XvZ5�, �► x ..E . G1
Date �� ZCL- 9 Permit
SOIL TYRZSaam-Clay-
Resul is of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEW
ABSORPTION F LD : Tot A ngtTi
Length of ea c trenc � �TP
Depth of trenc
Size of stone
SEEPAGE PITS : N ber-
Size - f „ x ft .
Stone size
PIPING : Size Type
Bldg . to Tank -l %t!A,
Tank to Dist . Sox %% V'
Dist .. Sox to Field/Pit
Openings Sealed . oPartial+ti p i
7 � Z"1�CJ
LOCATION/SEPARATIONS :
Foundat4on to Tank �]_ feet
Foundation to Absorption t 1t- feet
Separation of Pits feet
Conforms as per Plot Plan " es No
LOCATION OF SYSTEM ON PROPERTY : 00T Cc3"NLaE
( circle one )
Front - Rear Left Side - Right Side
Middle Front e -
COMMENTS :
VIA
SYSTEM USE APPROVED : YES (IW�
Arrived:
Departed :
Buf1ding nsp t
all abi ec:fs so* ass brAno wdh6 bow twomatev
. shown on this document 1 do e+rp t'Od 11ww
person ft dhiftem ad b0i m On d s ratan"
7.
DATE
PICOT PLAN
SEPTIC SYSTEM
Notice : The following statement must be " stamped " on your plat
plan . This sheet of paper may be used for purposes of drawing your
plot plan . After drawing such plot plan , please read the statement
and sign it . if you choose to use other paper for your plot. plan ,
the office will stamp those plans for your signature .
piwe seen or observed, or besifto # aM1� IlAb�,
cts ,uch as houses, welt„ ir+aM ftw&gft6
on this document. I abo r+eo wa ed t 01M
measured the distanoles srt % M aw8*40gW "`
SIGNATURE
TOWN Of QUEENSBURY BUIt_b1NG WARTMENit
Based an our ltmited examination.
p , `J compliance with our comments $MR MY
not he construed as indicating the
�� plans and specifications are in tul4 TC7"'
compliance with the code.
alp
46 as
II l
Z '�
70YV 3 of FILE COPS'
,PATE -. - - - / S