97-181 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date P.`t1r 2 19 97
C;
J\ 97:LC:f.
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 4 DORS T .T LACE;
Owner MOM? , ANDREW & DLLE N
By Order of Town Board
TAX 144AE' NO. 82 . 6-20 TOWN OF QUEENSBURY
4e-------
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97181
TAX MAP NO. 82 . -6-20 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to CUNNIFF , ANDREW & ELLEN
OWNER of property located at 4 DORSET PLACE 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
4 DORSET PLACE
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDER'S Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
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
SEPT' C ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID -THIS PERMIT EXPIRES May 1 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 1 Day of May 19 9
SIGNED BY / for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. 9 7-(87
Dept. of Community Development
Building&Codes Office 742 Bay Road Fee Paid $r OU
J
Queensbury, NY 12804
Location of property for installation:•
Property Owner's Name: / MDfPLj CU k.J i r f
Property Owne ' Mailing Address: Dor-cc-el-7-
Installer's Name: rrAill Phone # 7 9)- �?c
Number of bedrooms (if residential): 2 Total daily flow:
(residential -compute @ 51 •}-
• r>� V E D
Topography: flat, rolling, steep slope % of slope
MAY 1)1 1997
• Soil Nature: sand, loam, clay, other /depth: TOWN Of OLJEENSGURY
BIJI�pl1G ARID BODE
Ground water: at what depth? feet / Bedrock or Impervious Material: at-w`ira`e Fm —=--Te E
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 . i
• Septic tank: OaD gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: ' feet
Seepage pit(s): number of - / size each: _ ft. by k 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 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 cii+camstaace known by or on behalf of an applicant;shall be void.
• I have read the regulations with application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Dispo • ••• .
Signature of responsible person: AA-.0C Date: - 7-Y7
ilk .
f0
TOUN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road 0 QQueensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name N ( YOCV, Cii)A,ceLocation I) CoySe�, 2
Date S "17 Permit # (2V-)✓( YI •
SOIL TWE; .S.a.nd: am-C l ay-
Results P colation Test-
(if appli a e) Rate-Minute/Inch
TYPE OF SY EN:
ABSORPTI ' IELD: Total Length
Lengt of e ch ench
Dep, of tre ches-- _,._
Size of stone~
SEEPAGE PITS: Number- --T
Size - °c:P7., ft. x kc ft.
Stone size -
PIPING: Size Type
Bldg. to Tank FY--t 11-m
Tank to Dist. Box y e s A-)CIALAC
Dist. Box to Field/Pit ,K ;,�k LLD
Openings Sealed? 41100 ' a- Partial
LOCATION/SEPARATIO' :
Foundation to Tank (4,1, feet
Foundation to Absorption - - feet
Separation of Pits • feet
Conforms as per Plot Plan 'ei r
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
ro - Rear 'dam Ri ht Side
e Front -
c -LAC_ C_ .0�i ".)vy 1-3l,EE.
\--C-)? Lk" bc..1A t,\ ot3D E�
N7 V--W�U3K' .- Z." V-O i-k \t l
SYSTEM USE APPROVED: imam '.0
Arriv`
Dep,. ted• 4, "_. '
AL
Building r ,actor
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