98-435 CERTIFICATE 010 COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Da to 7t 19
aC15 . I L4 .--a- Lpa 98435
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 62 MT . VIEW LANE - -
Owner GILBERT E GERALDINE
By Order of Town Board
TAX MAP NO . 82 . - 2 - 18 TOWN OF QUEENSBURY
Director of Building Code Enforcement
BUILDING PERMIT
;r}?,7.1 FF" [:• �► TOWN OF 'QUEENSBURY No. 98435
TAX MAP NO . 82 . — 2 - 18 WARREN COUNTY, NEW YORK
pERMIS51+(3N is hereby granted to
GILBERTr GERALLDINE
dWtVER of property located at
62 MT . ,VIEW LANE Street, Road or Ave.
at the Town of Queensbury,
To Construct or place a SEPTIC ALTERATION
at the above location inaccordance to application together with plot plans and other information hereto filed a
nd
approved and in compliance with the Town of Queensbury Building and Zoning ordinance.
t. OWNER'S Address is
62 MT . VIEW LANE
gUEENSBURYr NY 12804
2. CONTRACTOR or SUILOERIS Name
SIGNORELLI & SON
3_ CONTRACTOR or SUILDERIII Address
589 WEST MOUNTAIN ROAD
QUEENSBURYr NY 12804
4. ARCHITECT'S Name
5, ARCHITECT'S Address
S, TYPE of Construction — (Please ind'cat a by KY SEPTIC
I Wood Frame [ } Mlasnnry i 1 Steel ( f
7. PLANS and Specif icstiOns
SEPM= ALTERATION AS PER PLOT PLAN 'SPECIFICATIONS
S. PropoedTCe
PSEI ALTERATION
July 17 2000
25 19
$ PERMIT FEE PAID — THIS PERMIT EXPIRES
vat be made to the Suitding and Zoning inspector of the
flf a longer period is required an application tot an extension m
town at Queensbury before the expiration date.l 1998
17 July
Gated at the Town of Queensbury this
Day of 19
Iv for the Town of Queensbury
SIGNED BY —
Suildir+q and onirg lnapactar
. ..,Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. f
Dept. of Community Developments
Building & Codes Office ,,/`Io
742 Bay .Road IN Fee Paid $
Queensbury, NY 12804
Location of property for installation: /' t G/�'r?i',w LQ�` -•
Property Owner's Name: ''
property Owner's Mailing Address: ( C 11,4G C, ej-XV Le', 64/
Installer's d
Name: je `0 jQ'e ( 1 ` Phone #
Number of bedrooms (if residential): -- Total daily flow:
(residential - compute 0 150 gal.lbdrm.)
Topography: flat rolling, steep slope % of slope
Soil Nature: son loam, clay, other 1 depth:
Ground water: at what depth? feet 1 Bedrock or Impervious Material: at what depth? feet
Percolation test: not required 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: 6t " gallon (minimum size: 1 ,000 gal.)
Tile field: each trench l feet I Total system length: / �`� feet
Seepage pit(s): number of I size each: ft. by ft.
Size of stone to be used: # A dearth or thickness feet
I40LDING TANK SYSTEM: (if required)
Number of tanks: Size of each.: gallons
Alariu 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 Queeusbury, 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 ]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 (}rdinance.
Signature of responsible person: hate: _
_ TOM1i OF QU
EENSBURY
�WjILDING 742
CODE Road
adRCE - ` c
Queensbury NY 1280A .
ois) 761-8256 C._ f { _
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date
Permit
SOIL TYP an¢- Loam-Clay-
Test-
Results of ercoRate�Minutellnch��
( if applicable )
TYPE OF SYSTEM: Total Le t •�-
ABSORPTION FIELD:
Length of each trencb,
Depth of trenches _L—
Size of stone Nber
SEEPAGE PITS : um wn fto x .
Size - -
Stone size Size Size yPe 0Tank
PIPINGto
Bldg • `" ID
Tank to Dist . BOX
Dist . Box to Fie IPYes ) No partial
Openings Seale TI
LOCATION/SEPA Tank l/ feet
Foundation t feet
Foundation to Abso X' tion feet
Separation o' Pits es No
Conforms as Per PI of P an E '
LOCATION OF SYSTEM ON
( circle one) Y Left Side R yrit Side
Front - Rear
middle Front - Middle Rea -
COMMENTS ' '
5
ArdZ
Ott
SYSTEMUSE APPROVED :
YES NO'�
Arrived:
Departed.
Bu,Idin9 Inspector
7
TOWN OF QUEERSBURY
BUILDING a CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12904
(51S) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name _ J51 /
Location _ lore G`t v I e000 v
Date 7 Z Permit #
SOIL TYPE: Sand- Loam- Clay-
Results of Percolation Test-
( if applicable ) R to-Mi t Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : T t L n h
Length of each trenc
Depth of trenches
Size of stone
SEEPAGE PITS : Numb
r- f t .
Size - ft .
Stone size
PIPING: Size
Bldg . to Tank
Tank to Dist . Box ,
Dist . Sax to Field/P
Openings Sealed ? es Na artia
LOCATION/SEPARATIONS : feet
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits
Conforms as per Plot Plan a No
LOCATION OF SYSTEM ON PROPER .
( circle one )
Front - Rear - Left Side - 4Cight Side
Middle Front - Middle Rear
COMMENTS : R�ci
SYSTEM USE APPROVED : CYE) No
Departed :
Arrived:
Departed :
Building Inspector
maON;. .�17 12.4'
LA �
f
�n
woa 1, i -inr
r
a
have seen or observed a Objects such as houses ar believe l saw
s own on this docu • wells% trees evidence at,
p onall meat l also re . fences, etc.,
u Y rhea ured th Aresent that l have
sh s ck dis es set forth an the diagram.
"