97-235 . •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
3oiL
This is to certify that work requested to be done as shown by Permit No. 97235
has been completed.
• This structure may be used as a SEPTIC ALTERATION
Location 28 FERRISS DR.
IOR T.141: , JAMES' & :JODI
Owner •
By Order of Town Board
TA0i." HAP NO. 121 , -14-26 TOWN OF QUEE SBURY
rat,
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97235
TAX MAP NO. 121 ..-14=26 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to FIORINI . JAMES &' JODI
OWNER of property located at 28. EERRISS DR. Street,Road or Ave.
in the Town of Oueensbury,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 with the Town of Queensbury Building and Zoning Ordinance.
1..OWNER'S Address is
28 FERRIS .DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name,
SMITH FRED
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. "ARCHITECTS Address
6.-TYPE of Construction—(Please indicate by X)
SEPTIC.
( 1 Wood Frame ( I Masonry ( )Steel l )
7. PLANS and Specifications
SEdt'dPIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
B. Proposed Use
SEPTIC ALTERATION
2.5 May 15 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.)
15 May 97
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
Building and oninglnspe
—. . Anpiicatiou for • .
STAMP RECI IVED\ 5ErTIC DISPOSAL PERMIT
Location of properix for Installation: flxp'.s ilk •
PERMIT NUMBER
Owner's Name: JA CoR)r 14 Z "0 Q ���
Address: �13 Pad e
35
Installer's Name: /K c ' 5/21/-J-� Pl l PAID
Phone #: (3d) '79 / J�
Number of bedrooms (if residential):
Total daily How (residential -compute ail 150 gal. per bedroom): 5-0
Topography:. • Flat h Rolling 1-1 Steep Slope 4' of Slope
Soil Nature:, Sand n I.oatnEl Clay El Other /I)clith:
Ground Water: at what dgpth7 • feel
. RECEIVED
Bedrock or Impervious Material: at what depth? • feet
. MAY 1 5 1997
Percolation Test: ( .Not Required r1 Required/Rate min. p.ir inch
TOWN Of CtiE. 3URY
' Donrektic Water Supply: . -7*.fs;Municipal (-1 Well [--1 Other - BUILDING AND CODE
If domestic water supply is a,WEI.i; water supply from any septic absorption is feel .
.
PROI'OSlill SYSI'iM: '
Septic lank: U" gal. (mini rum size: •1,0(10 gal.) •
Tile Field: each trench 0 feet. / total system length o2(11) feet.
Seepage Pil(s): number of ' / size each: ft. x • ft.
Size of stone to be used: # / depth or thickness feet.
1101.,1)1NGTANK SYSTIIM: (if required)
Number of tanks: . • lI Size of each: . gal.
•
i11.,i Alarm system aitd associated electrical work to be inspected by a certified agency.
•
For your protection, pleaseI note that pursuant to Section 136-29 of the Code of the Town of
Queensbury, any permit oY approval granted which is based anon or is granted in reliance upon
any material iuisrepreserttgtion or failure to make a material fact or circumstance known by or on .
behalf of an applicririt, shall be void. •
1 have read the regulations with respect to this a p jrlication and agree to abide by tbesi and all
1 requirements o f the Towno f Qneensbur r itary Sewage Disposal Ordinance.
i . . /4 ' Q7
Sf enature o f t,eStlo?t,lble person: __ Dart':
i (53 -C'
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT f U,,U 5
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
e
Name �A-C*-f.\\, , \Y -ej
Location c 'ev-V- I's S OO-Q,
Date 57X07Permit_ # _97.7a_ __35, _
SOIL TYP : San am-Clay-
Results of Percolation Test-
(if applicable)'A''t_ e-Minute/Inch
TYPE OF SYSTEM: + -'
ABSORPTION FIELD, Total Length t
Length of each ench 1-f 51
Depth of trenches V
Size of stone zi
SEEPAGE PITS: -;Number-
Size - ft. x ft.
Stone size .�
PIPING: Size Type
Bldg. to Tank EV,-rjo\(-)
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank4eet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan C Us-No
LOCATION OF SYSTEM ON PROPERTY:
(circle one
Front - :ear / 100- : 'ght Side
Middle Front - .. e Rear
COMMENTS: •
SYSTEM USE APPROVED: 4110111 - 0
Arrived: r �
� . )400(
Depart-1 AIM
i :willing • .c or
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-1-.ORWN.E..0-PC:i.J36."111/19:9Q''e.37::
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, .
, PLOT PLAN
? . . SEPTIC SYSTEM
. '• I: •
Notice: The following statement must be "stamped" on your plot
' plan. This sheet of paper may be used for purposes of .
drawing your plot plan. After drawing such plot plan,
. please 'read the statement. and sign it . • If you choose to
use other paper for our plot plan, tie office will stamp
those plans for yo . sign. - 1 - - -
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: Have seen or observed, o; betieve I saw evidence of,
;I objects such as houses, wells, trees, fences, etc.,
....jA _ . i •
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• . • shOwn on this document I also represent that I have ,
• ., peisonally measured the distances set forth on the diagram."
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' • SIGNATURE DATE
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N: OF QUEENSBURY
. ' "I have seen or observed, or believe I saw evidence of, .
BUILDING (1-r• rODP.i' DEPT. all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have
• . RDEAVTi -WED BY ' . ., •,..•
71 • - - personal SIuGrr
NedA It UieR Ed isances set forth o hii# a in_.
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