97-099 CERTIFICATE OF COMPT,IANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
Id\ \ a)- 1-1 .1..1 1
This is to certify that work requested to be done as shown by Permit No. 970_99
has been completed.
• This structure may be used as a SEPTIC ALTERATION
Location 234 AVIATION RD .
Owner GAGNON. DONNA J.
By Order of Town Board
TAX GAP WO. 'x 9 . -2-2 . .1 TOWN OF Q N URY
(3atie _ .
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 97099
TAX MAP NO. 79. -2-2 . 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
GAGNON, DONNA J.
OWNER of property located at
234 AVIATION 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
236 AVIATION RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
CONDON SEPTIC & DRAIN SERVICE
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 ( 1
7. PLANS and Specifications
SEPT C ALTERATION AS PER PLOT PLAN SPECIFICATIONS _
8. Proposed Use
SEPTIC ALTERATION
25 March 27 99
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(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.)
27 • March 97
Dated at the Town of Queensbury this Day of 19
SIGNED BY l- i1/1->j?.- .%1.�14/\ for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
r
Town of Queensbury
Community of Community Development
Permit No.CA
Building &Codes Office r�
742 Bay Road Fee Paid S cl5
Queensbury, NY 12804
Location of property for installation: r Ai
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•
Property Owner's Name: 6 W (f7/VA-- 4- N a i�
MAR 2 6 1997
Property Owner's Mailing Address: 013 6 Aul %/o f�"!
Installer's Name: (7j atiti1ii S 3Q �G Cf , l�l/U.S APhone # 7 l '= �
Number of bedrooms (if residential): Total daily flow: //SO
(residential - compute @ 150 gal./bdrm.)
Topography: /X flat, rolling, steep slope % of slope
Soil Nature: X sand, loam, clay, other I depth:
Ground water: at what depth? 4 feet / Bedrock or Impervious Material: at what depth?`j/�feet
Percolation test: _ X not required, required [rate min. per inch]
Domestic water supply: X municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
}
PROPOSED SYSTEM
Septic tank:0 63 gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system leth: feet
Seepage pit(s): number of 2- / size each: ft. by e ft.
Size of stone to be used: # 3 / depth or thickness Z feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
&larm 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 application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
3 ; i P
Signature of responsible person: � ;. ?� Date:
TO OF QUEENSBURY /2)
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ( qc�� I � Yy (-N
231 n �,J
Location
Date d Permit # C17—0
SOIL TYP San -Loam-Clay-
`.
Results o . Percolati Test-
(if applicable) Ra inute/Inch
TYPE OF SYSTEM:
ABSORPTION FI D: T al Length
Length of ch trench
Depth of renches
Size o stone
SEEPAG PgS: Number-
Size - 'j ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box S�JCZ 3S�
Dist. Box to Field/P:.
Openings Sealed? No Partia
LOCATION/SEPARATION'..
Foundation to Tank f eet
Foundation to Absorption �.�i/ feet
Separation of Pits 410
r�'feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPER'
(circle
Front - Rear Left Side - Right Side
Middle •' Middle Rear
COMMENTS:
•
SYSTEM USE APPROVED: NO
Arrived: 2- D-,�
Departed:
JAL.
Building Inspector
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