97-179 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
• .
Date Hay 13 . 19 97
'
71'7 9'
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 19 WINTERGREEbi RD . • .
Owner ,JORDAN, GRACE A. /TREFFI
B Order of To n 13!ard
TAX HAP NO. 119 . -5-13 WN0 DUE*
Director of Building & Code Enforcement
— •
• ,
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97179
TAX MAP NO. 119 . -5-13 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to JORDAN, GRACE A. /TREFFI
OWNER of property located at
19 WINTERGREEN RD. Street,Road or Ave.
To Construct or place a SEPTIC ALTERATION
in the Town of Queensbury,
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.
t. OWNTi GLENs
WOOD AVE.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
CONDON'S SEPTIC & DRAIN
3. CONTRACTOR or BUILDERS Address
0
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
( )Wood Frame ( I Masonry ( )Steel (
7. PLANS and Specifications
SFTIC ALTERATION. AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 April 30 19 99
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
30 April 19 97
Dated at the Town of Queensbury this Day of
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
.. Application)location for SEPTIC DISPOSAL PERMIT o
II.
• STAMP RI.:C:1:1 VI:1) Z
Location of properly for installation:19l(f`'I1/#A/i-Frirn 3)6Z- O
Uwuer's Nam cerrt7 4-0 E `ZJ L ..p/4N • PERMIT K)
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Owner's Mailing Address: Gii .'Wald AVE —•C 7
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S �±w-U eta: PAT[) a� , z
Installer's Nanic.11lOhili ,r ?"/1 G Phone #: 791 e J 7 L (.....)
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tci
Number of bedrooms (if residential):
>�
Total daily flow (residential -compute rn l I5O gal. per edrexmr): .3 6 G
Topography: [4 Mat , t7 Rolling r1 Steep Slope 4b of lc
Soil Nature: (X Sand Loam I—I Clay Other /I,cjiFtx.
� APR • •
Ground Water: at what depth? feet `�
��I�vr ;.s '99�
Bedrock or Impervious Material: at what depth? -44.- feel BLII �a1
/nlp lrop�
Percolation'I'est: 1510 Not Required r1 Required/Rate min. per ins r
Domestic Water Supply: Municipal E1 Well Other
If domestic water supply is a WELL: water supply from any septic absorption is feet
PROPOSED SYSTEM: •
VP
Septic tank;[1--J gal, (minimum size: I.000 gal.) -
Tile Field: each trench la feet_ I total system length 2'49 feet. •
Seepage Pil(s): number of I size each: • It z ft.
• Size of stone to be used: # 9— I depth or thickness I• feet-
HOLDING TANK SYSTEM: (if required) ' -
.
• Number of tanks: • Size of each: gal. . '
''.Alarm system and associated electrical! ork to he inspected by a certified agency.
• Z_
For your prorec:titz,r„phase note that pursuant to :Secririir`136-29 of lire Cade of the 7.0111I of
' Queensbury, any permit or approPul granted which is based upon or is granted in reliance upon
•any material misregfesernation or failure to make a material fact or circumstance known by or on
' behalf of,au applicant, shall be•r'oid. •
I have read the regulations wit/r respect to this application and agree to abide by these and all
requirements of the Ton•n o f Queensbury Sanitary Sewage Disposal Ordinance. /� Q �j
Signature o jresponsib'e person:raj"' Date: / ~ 2 / 9 7
OF QUEENSBURY
BUILDING �, CODE ENFORCEMENT -
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name rcQcat .
Location c.-M4-e
Date ( Permit # 77- /7 /
SOIL TYPE: and Loam-Clay-
Results of colation t-
(if applicable) Rate-M' to/Inch
TYPE OF SYSTEM: cl i
ABSORPTION FIELI: Total math 'O
Length of each trenchi D
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type ;in
Bldg. to Tank 112.11 T
Tank to Dist. Box o
Dist. Box to Field/PO / 4 'I
Openings Sealed? No Partial
LOCATION/SEPARATION .
Foundation to Tank feet
Foundation to Absorption 5 feet
Separation of Pits e:
Conforms as per Plot Plan Y-e/
LOCATION OF SYSTEM ON PROPER .
(circle •
Front 'ear - Left Side - Right Side
Middle F :- - Middle Rear
COMMENTS: •
�EL 45 ---EUjLr r4_I,AJ
•
SYSTEM USE APPROVED: IN, NO
Arrived: SS—
Departed:
Building Inspector
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U§LD§NG DEPARIMENi MAY 1 3 1997
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