98-350 CERnFIC.ATE oji, COMPLIANCE
TOWN OF QUEENSBUR'Y
WARREN COUNTY , NEW YORK
y Date .Tune: -25 19 99
,0 55 98350
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
3 VERMONT AVE ,
Location
Owner T3UNPHY , GEORGE & RI'T'A
TAX MAP NO 128 . - 3 - 7 By Order of Town Board
TOWN OF QUEENSBURY
zxx
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF +QUEENSBUR.Y No.
TAX MAP NO . 128 . — 3 - 7 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to �. QUNPHYx GE
OWNER of property located at 3 VERMC3NT VEM Street, Road or Ave.
in the Town of Queensbury. To Construct or place a SEPTIC AT TFR ATTON 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 Clueensbury Building and Zoning Ordinance.
1. OVVNER'S Address is
3 VERMONT AVE .
QUEENSBURYr NY 12804
2. CONTRACTOR or BUILDER S Name
DUNPHYr GEORGE
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
IIIIIIII Jill
6, ARCHITECTS Address
6. TYPE of Construction — (Please indicate by X) SEPTIC
l wood Frame I ! Masonry ( I Steel I I
7. PLANS and Spells
SEP'f3'IC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
a. Proposed Use
SEPTIC ALTERATION
25 June 19 2000
S PERMIT FEE PAID — THIS PERMIT EXPIRES , 19
(If a longer period is required an appiicetion for an extension must be made to the Swlldim and Zoning inspector of the
town of Oweansbuty befor* the expiration detail
19 June 1998
Dated at the Town of Gueensbury this Day of t9
SIGNED BY for the Town of Queensfwry
ifditeg and oninp I nsprclar
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury "+
Dept. of Community Development Permit No.
Building & Codes Office JUN
742 Bay Road Fee Paid $ CO'� a) .
Queensbury, NY 12804
Location of property for installation:: 3 ye k'�sfnai! oy-a
Property Owner's Name: Seep r` A L. i A :1 ty Pk V
Property Owne g Address: l3 f 41F ,hl 54-/ .
Installer's Na Phone # f7 �
Number of bedrooms (if 4idential): Total daily flow:
(residential - compute a 150 gal.Jbdrm.)
Topography: ✓flat, roiling, steep slope % of slope
Soil Nature: `sand, lost$ clay, other 1 depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _,_, feet
Percolation test: not required, required [ rate nvn. per inch ]
Domestic water supply: Z municipa.l, well, other
If domestic water supply is a WELL, water supply from any septic absorption isA—aaaaaAaa feet.
PROPOSED SYSTEM
Septic tank.: /#VO gallon (minimum size: 1 ,000 gal..)
Tile field: each trench feet f Total system length: feet
Seepage pit(s): number of J 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 certifced agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queenisbury, any permit or
approval granted which is based upon or is granted in reliance upon any material misrepr easentation or failure to makes 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 applic ' and agree to abide by thAe and all requirements the Town. of
Queensbury Sanitary Sewage Disposal
Signature of responsible pers
TOWN OF QUEERSRURY
BUILDING s CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(5L8) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date�_ ermi t #�
SOIL TYPE- Loam- Clay-
Results of Perc+ol ati on Test-
( if applicable ) Rate to/ Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : otal ngth
Length of ea h tr Inch
depth of tre the
Size of stone
SEEPAGE PITS : umber- 011
f t ;X
Size - � f
Stone size _ — , Type
PIPING: Si ' T Z.
Bldg . to Tanis
Tank to Dist . 'Box
Dist . Box to Field/
Openings Sealed? Yes No Partial
LOCATION/SEPARATI �j feet
Foundation to Tank Absorption -' — feet
Foundation to eet
Separation Of Pits
Conforms as per Plot Plan .ER ye No
LOCATION OF SYSTEM
( circle one)
Front - Rear - L ft Sid - Right Side
Middle Front - Mi ear
COMMENTS:
SYSTEM USE APPROVED : DYESNo
Arrived :
Departed :
Building Inspector
M1
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Say Road
Queensburyy NY 12804
(518) 761 -8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name --
Location OA) ='
Date Permit #
SOIL TYPE: Sand- Loam-Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM:
ABSORPTIOW FIELD : T tal Le gth
Length of e4ch tre ch
Depth of tre hes
Size of stone
SEEPAGE PITS : Nu ber.
Size - ft , x ft .
Stone size
PIPING : Size Type
Bldg . to Tank
Tank to Dist . B x
Dist . Box to Fi ld/Pit
Openings Seale Yes No Partial
LOCATION/SEPA TIONIS :
Foundation to ank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan i Yes No
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS :
SYSTEM USE APPROVED: YES N
Arrived :
Departed :
Building Inspector
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tIRECEiVED
JUN 141999
TOWN OF QUEENSBURY
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