97-092 vs-
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CERTIFICATE
OF COMPLIANCE
TOWNOF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
3 (A
This is to certify that work requested to be done as shown by Permit No. 97092.
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location 64 .10EN ST.
Owner LEONBRUNO„ MICHAEL
By Order of Town Board
TAY MAP NO, 121 , —1- 16 E.;8 TOWN OF QUEENSBURY
Di rector of Building 81. Code Enforcement
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BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 97092
TAX MAP NO. 121 . —1-16 . 58 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LEONBRUNO, MICHAEL &
OWNER of property located at 64 JOHN ST. 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 filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
LAURIE 64 JOHN ST.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
I. B. S . SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( I Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 March 25 19 99
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 25 Day of March 19 97
SIGNED BY 1,� C /\, for the Town of Queensbury
uilding and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
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Town of Queensbury Permit No. -1-0 C�
Dept. of Community Development" _._ -
Building &Codes Office ri••';�`1. '" "
742 Bay Road ` ' •.. Fee Paid $
Queensbury, NY 12804
MAR 2 5 1997/, _ ---
Location of property for installatoi�,�"''` ;'.;; ' = K,2E S I
Property Owner's Name: 6 0-0 'ram.O
Property Owner's Mailing Address: O i.4- S. I
Installer's Name: 1..., 4!. (3I ,c 5 d 1�i C- Phone # ? 9 .e-
Number of bedrooms (if residential): Total daily flow: ffd 9'9` C-
(residential - compute @ 150 gal./bdrm.)
Topography: t, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, ocher /depth:
Ground water: at what epth? feet / Bedrock or Impervious Material: at what depth? _feet
Percolation test: • not r ed, required [rate min. per inch ]
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:/00 0 gallon (minimum size: 1,000 gaL)
a 0
Tile field: each trench 5 a feet / Total system len the 6 feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # 4 / depth or thickness I 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 note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or
approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a
material fact or circumstance known by or on behalf of an applicant, shall be void_
I have read the regulations with respect to this app" • and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance i
/� res
Si ature of nsible person: / ✓ :T?'Date �)
1»
TOUN OF QUEENSBURY I)
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury by 12804
518-745-44.47
SEPTIC DISPOSAL SYSTEM INSPECTION
Name . I(0 )40A
Location `4U\A
Date 3j j19-Q`7 Permit # -09a,
SOIL TYPE: Sand-Loam-Clay •
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Results of Percolation Test-
(if applicable) Rate-Minute/Inch aJ/-•
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length ,_�GU
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. Ic . ft.
Stone size
PIPING: Sri Type
Bldg. to Tank
Tank to Dist. Box 4./te
Dist. Box to Field/Pi % PAL
Openings Sealed? or. No Partial
LOCATIO!/SEPA',,TIO 1
Foundation to Tank w,J�-feet
Foundation to Absorption � ; feet
Separation of Pits k Meet
Conforms as per Plot Plan Ammo, No
LOCATION OF SYSTEM ON PROPER' r
(circle oa_-
Front 'ear- - Left Side - Right Side
Middle ront - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES' MO
Arrived: (.t o
Departed:
Building Insp +ctor
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