98-482 CERTIFICATE 01P C(J:1V. P IANCE
TOWN OF QUEEMSBURY
WARREN COUNTY , NEW YORK
bate August 6 19 98
16
This is to certify that work requested to be done as shown by Permit No . _
has been completed .
SEPTIC ALTERATION
This structure may be used as a
23 EAST BRANCH DR .
Location Y '
COOK * WILLIAM & QORI5 , L . E
Owner
By TAX MAP Nc� . 133 . - 1 - 6 Order of Town Board
T}OWWNN OF qUEENSOURY
�'--- Director of Building S Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY
TAX 14AP NO . 133 a — 1 - 6 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
Street. Road or Ave.
OWNER of property located at 23
in the Town of 'OueensburY• To Construct or place a
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 Oueensbury Building and Zoning Ordinance.
FARCHITIECrSNams
S Address is
AST BRANCH DR ,
NSBURY , NY 12804
CTOR or gUI t DE R 5 Name
TARY SEWER
ACTOR or SUILMR'S Addrew
DRELLOS PO BOX 224
S FALLS NY 12801
TECTS Nana
TECT'S Address
6. TYPE of Construction — (Plows indiasce by xl SEPTIC
i 1 VVtrod Frame 1 1 Masonry t l Steel l 1
7. PLANS and SpecNiiasnions
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
ra. Propo ed Use
SEPTIC ALTERATION
25 August 6 t9 2000
$ PERMIT FEE PAID - THIS PERMIT EXPIRES gy��itgard Zoning inspector of the
lit a longer Period is rewiv*d an application for an extension most be made to t
tw tow++ of C psensburV tutors the sepiration deteS 1 August 1998
Oared at the Town of Dueenabury 'this Day of
19
for the Town of OueenSI
SIGNED BY
Qlvilding aea coattta inopectm
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No.
Building & Codes Office fir' p i>
742 Bay Road Fee Paid $=ISM
Queensbury, NY 12804
Location of property for installation:
Property Owner's Name: V"`"'' fv� • /� {
Property Own 's Mailing Address: �.1 .x�} et x �
Installer's Name: 494=� Phone # 77 172- +T Z- 1' 7
Number of bedrooms (if residential): - Total daily flow: 0 zza
(residential - compute a 150 gal.lbdrm.)
Topography: GL/I flat, rolling, steep slope rb of slope
Soil Nature: (0 sand, loam, clay, other l depth:
Ground water: at what depth? feet J Bedrock or Impervious Material: at what depth? . feet
Percolation test: "'� trot required, required [ rate min, per inch
Domestic water supply: m cipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank: Oc�J gallon (munmum size: 1 ,000 gal.)
Tile field: each trench feet I Total system length: feet
Seepage pit(s): number of t 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 certified agency.
For your protection, please note that pursuant to Section 136r29 of the Code of the Town of Queensbury, any permit or
approval granted wbich is based upon or is granted in reliance upon any matarud misrepresentatum or failure to make a
material fact or circumstance known by or on behalf of an applicant, sball be void.
I have read the regulations with respect lication and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposna")Signature of responsible person: Date:
TOYN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location �:
Date Permit #
SOIL TYPE * an - am- Cl ay-
Results Percolation Tes
( if appl cable ) Rate-Minut /Inch 1
TYPE OF YSTEM:
ABSORPTI FIELD*= Total Le gth LI
Length o each trench
Depth of renches
Size of s one
SEEPAGE P TS : Number- �
Size - ft . x _
te
Stone size
PIPING : Sizee
Bldg . to Ta 5►
Tank. to Dist Box t �
Dist . Sox to field/Pi
openings Seal ? Y s0 artia
LOCATION/SEPA IONS VZ feet
Foundation to T k feet
Foundation to Ab tion
feet
Separation of Pit es o
Conforms as per P1 t Plan
LOCATION OF SYS
( circle one ) Right Side
Front - Rear - e t e g
Middle Front - e ar
COMMENTS :
SYSTEM USE APPROVED: NO
Arrived: I�'r
Depart
Buii Ing nsp
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM tINSPJECTLON �
Name — c)
Location Date '_ Permit #
SOIL TYPE: Sand- Loam-Clay- `~ 480
Results of Percolation Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS : Number-
Size - ft * x ft .
Stone size
PIPING : Size ype
Bldg . to Tank
Tank. to Dist . Box
Dist . Box to Field/Pit
Openings Sealed ? Yes----ffO arts a
LOCATION/SEPARATIONS : feet
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
( circle one )
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS :
IMP 1 N1 P C_1 )C ' VE- #
SYSTEM USE APPROVED :
Arrived
,.
-1 di g ecto
i
COOKE SEPTIC SYSTEM
T --
T
133. -5 /
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133.-1 -4
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Produced by the Town of Queensbury, MY, Building Department 1°°+z
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❑6103/1998
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