97-219 •
. . . .
CERTIFICATE
OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
. .
ilay 9"
•.
This is to certify that work requested to be done as shown by Permit No. 9721
has been completed.
• •
This structure may be used as a SEPTIC ALTERATION
Location 25 CARLTON DR .
Owner LA 1?IERRE„ BRUCE & NANCY ,
• By Order of T wn Board
TiX MAP NO . 72. -3-31
r
Director of Building & Code Enforcement
•
BUILDING PERMIT
TOWN OF QUEENSBURY No.
VALUE $ 0 97219
TAX MAP NO. 72 . -3-31 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LA PIERRE , BR-UCE & N dCY
OWNER of property located at 25 CARLTON DR. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTE ''PION
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
25 CARLTON DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
I . B. S . SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( )Steel ( ISEPTIC
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES May 12 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 Of LePn_bury this 1 bay of May 19 97
SIGNED BY for the Town of Queensbury
Buil and Zoning Inspector
•
Application for SEPTIC DISPOSAL PERMIT .
Town of Queensbury '' Permit No. .,. 19
-
Dept. of Community Development ., / — -
Building &Codes Office C. b 6
742 Bay Road Fee Paid $d j„
Queensbury,,NY 12804 •--wa
Location of property e for installation: �c . CO( 7`01, ''�..'•
P
/1
Property Owner's Name: /0"- C (c.- ee �� C'ti i `iY. .,
Property Owner's Mailing Address: ,- 5 (c<r( /d-
Installer's, Name: /... ( 8 , ( S('Q��� Phone # 77S "—�/ Yc(
'. Number of bedrooms (if residential): 3 Total daily flow: C . 6 .
(residential - compute @ 150 gal./bdrm.)
Topography: fla. rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
' : Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? — feet
Percolation test:/LI/7 not required, required [rate min. per inch]
Domestic water supply: unicipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. ,
•
PROPOSED SYSTEM
Septic tank/�00 gallon (minimum,size: 1,000 gal.)
' Tile field: each trench feet / Total system length: fee '
Seepage pit(s): number of / size each: . ft. by &RECEIVED
Size of stone to be used: # ' / depth or thickness ( feet MAY 0 7 1997
.TOWN OF QUEENS3URY
. BUILDING AND CODE
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 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 S,mitary Sewage Disposal Ordinance
Signature of responsible person: 6,ge4e9 Date: c '
TOWN OF QUEENSBURY
BUILDING 8 CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECT •N
Name '�C A- J/G,ri2C'
Location '-&S- <!,9YreC , J 4004'4,
Date IP 97 Permit . 97 .2/9
SOIL PE: Sand-Loam-Cl .y
Result of Percolatio Test-
(if apilicable) Rate- inute/Inch
TYPE 0'' SYSTEM:
ABSORP '',ION FIELD: Total Length
Length .f each tre ch
Depth o trenches
Size of stone
SEEPAGE 'ITS: N mber-
Size = •t. x ft.
Stone siz-
PIPING: Size Type •
Bldg. to Tank
Tank to Diet Box
Dist, Box to, Field/Pit
Openings Se:led? Yes. .' No Partial
LOCATION/S%P RATIONS:
Foundation to Tank feet.
Foundatiot to Absorption feet
Separati. of ''its feet
Conforms as pe Plot Plan Yes No
LOCATIi•- OF SYS M ON PROPERTY: .
(circle one)
Front Rear .- Le t Side - Ri.ght Side
Middle Front - Mi . .l a Rear
COMM' S:
k /64-Fp ^ 01
SYSTEM USE APPROVED: dip NO
Arrived:
Departed: 3 '. 5- ..
Building Inspector
TOWN OF QUEENSBURY \ c) )7)
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DI 'OSAL SYSTEM INSPEC ON
Name -),( ' e_ , _ _ '
"`c7 OC_Q_
' 6Location r C d A I v- ,
Date - 't • / PerTnit . ,-a
ICI
SOIL TYPED Loam-Cl .,y-
Results of Perc.latio Test-
(if applicable) Rate- inute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELi : T.tal Length
Length of each ire h
Depth of trenche.
Size of stone
SEEPAGE PITS: N ber- '_
Size - (°5 f x e ft.
Stone size
PIPING: Size Type
Bldg. to Tank C 17Z'2S
Tank to Dist. :ox 1/" p 90
Dist. Box to i el d/"^ .i. it
Openings Sea ed? � . No Partial
LOCATION/SE'ARATIO
Foundation -o Tank .-feet
Foundation to Absorpt'on ; C) feet
Separation of Pits feet
Conforms n s per Plot P an AED No
LOCATION IF SYSTEM ON ' 'OPER
t1 e ,ne)
rorit 'ear - Left Side - Right Side
e ' ront - Middle Re.r
COMMErS:
6, , ; e.-Pr& ? /6 ��r�
0I % Ov6-K ./1-u_ g u7 Ur),
SYSTEM USE APPROVED: YES 101
Arrived: /= 61)
Departed: / • 70
Building Inspector
•
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TOWN OF CAIEP_Y4aE.M ill.MDfN DEPARTMEN UII.,DA c._AND CraD ,
Based` ,:wF. reito'i 4:.p.111-atitm, : _ - -
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