97-114 CERTIFICATE OF COMPLIANCE
• TOWN OF QUEENSBURY
WARREN COUNTY, NEW. YORK
Date , Arri -7 19 tri
97 " 4
This i 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 18 PINEWOOD RD.
Owner DE: WITT p PRANK & GAIL
By Order of Town _Board
TAX HAP NO . 126 . -2-9 • TOWN OF QUEENSBURY
•
Th.
Director of Building & Code Enforcement
. .
BUILDING PERMIT
•
VALUE $ 0 TOWN OF QUEENSBURY No. 97114
TAX MAP NO. 126 . —2-9 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to DE WITT, FRANK & GAIL
OWNER of property located at 18 PINEWOOD 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 filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
18 PINEWOOD RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
SMITH, FRED
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES April 3 19 99
(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 3 Day of April 19 97
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
1S-Akr
+/-/60.-3 O/1 71 ncJn; (t;.+,eltirh Ka ( J5/d)
51-At1•tI' ILI;C'11 V1:1)
SEPTIC DISPOSAL PERMIT
Location of pruperix for Installation: I
IS gjeaoc ed I PERMIT NUMBER
Owner's Name: dZ f / / �
Address: Ii Rivo.`�.L.ci Z-i
1 p
Installer's Name: EL) 521/#1 Flat: PAID 1
I'Ilone #: (s/C) 794r/t'' .
Number of bedrooms (if residential): `1
Total daily flow (residential -'compute OD 150 gal. per bedroom):
•
Topography: '17Iat [l Rolling Steep Slope If; of Slope
Soil Nature:
Sant ElI ttnnt (lay Other /Ucptlt: — = ti;t .,p ,`
i
Oroundfeet • \ OR V 1997
Water: at what depth?
feet ...�, ;
Bedrock or intpervjous Material: at what depth? -•.: ,IN . _
Percolation Test: 1 -t Not Required {•1 Required/ltnlc min. per Inch
Domenic Water Supply: Municipal 1----1 Well ri Other
'
If domestic water supply is a-WILL water supply from Any septic absorption is feel
PROPOSED SYSi'1 M: '
Septic tank:AO gal. (minimum size: 1,000 gal.)
'life Field: each trench feel. / total system length �t �t
`�L' feet.
/
` size each: ft. x ft.
Seepage I it(s): number of
Size of stone to be used: # •04- / depth or thickness rkViac`et.OF QUEMSBLIFY
1110::
(ifrcyuircd)or tanks: Size of each: gal. P E1l1 W:D
il
1y:' work to be inspected by a cirri-fled rr eney. "�'
1J� Alarm system a�rd associated electricalI
i
, For your protection, please note that pursuant to Section 136-29 of the Code of she Town (If
Queensberry, any permit of a pproval granted which is based upon or is granted in reliance upon
any material misrepresenrri<riort or failure to make a material fact or circumstance known by or on
behalf of an applicant, shirt, be void.
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1 have read the regula►iorts with respect to this application and agree to abide by these and all
requirerrrents of the Town of Queensbury , Anita . Sewage Disposal Ordina,, :e.
J)atc:
Sit's:ware.o f resuonsible person: �. . 1iZ� /
€1' ecZ(.46
TOM OF QUEENSBURY
BUILDING E CODE ENFORCEMENT
531 Bay Road ((�n�
Queensbury NY 12804 ""�'
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name G C2\ 00f J 6
Location /6 ��i1 r'pvs(
Date l%/7 Permit # 7-//•Y
SOIL TYPE: Sand-Loam-Clay-
Results of Percol •tio Test-
(if applicable) Ra `; Minute/Inch
TYPE OF SYSTEM: -�
ABSORPTION FIELD• Tot.l, Len 0
Length of each french ,)()
Depth of enches
Size stone b
SE GE PITS: Number-
ze - ft, x ft.
Stone size
PIPING: Sjze Type , 22
Bldg. to Tank t�[ y'
Tank to Dist. Box
Dist. Box to Field/Pit w
Openings Sealed? Yes No Partial
LOCATION!/SEPA' TINS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits iiip-et
Conforms as per Plot P1 an No
LOCATION OF SYSTEM ON PROPERP
(circle
Front - Rea - Left Side - Right Side
Middle F t - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: NO
Arrived: 0 r i
Departed:. //0 5
Building Inspector
•
1 .
)1 .`
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TOWN OF.QUEENSBURY BUILDING DEPARTMENT
" - . Based on our limited examination,
compliance with our comments shall
not be construed as indicating the
plans and specifications are in full
PLOT PLAN compliance with the code.
SEPTIC SYSTEM
Notice: The following statement must be "stamped" on your plot
' 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.
•
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,1 YENS
��:. i y, APR 03 1997
BOLDING 87h C40 V. Paz. WAS TOk' �r, _VJFE!' :.�
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•
aDATE fe -/-17 '
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vvilakiV,/
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"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have
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person 4T(IE
ured t iie distances set faith on the diagram."
UATE