97-204 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Li-°17 p 19 q 7
This is to certify that work requested to be done as shown by Permit No. 97204
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location - 6 3WEETBRIA1 LANE
Owner WTJl1R EMAN 5 PETER c ANNE
By Order of Town Board
TAN 14P117 NO, 80 . --1-25 . 66 TOWN OF QUEENSBURY
a
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97204
TAX MAP NO. 80. -1-25 . 66
WARREN COUNTY, NEW YORK
WUERDEMAN, PETER &, ANNE
PERMISSION is hereby granted to
6 SWEETBRIAR LANE Street, Road or Ave.
OWNER of property located at
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. OwNF6R ` ARIAR LANE
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
I. B. S . SEPTIC
3. CON y AE69114KB hyawd TREET
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
( )Wood Frame ( I Masonry ( I Steel ( I
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 May 8 99
$ PERMIT FEE PAID -THIS PERMIT EXPIRES 19
(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.)
8 May 97
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
B it mg and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT 1 O
SI'AMI' RECEIVED y
0
Location of property for inslallalion: ( Gc, f
Owner's Name, P I C r cjue r de(- �'``.- '^, - t 9PERMIT NUMBER
Owner's Mailing Address: W 6 ./ C.'�se C/ dral(f. �� Utri
I1
/' FEE PAID z
Installer's Name: L r I1 r r See/ LC- ."Phone #: 2,s----wi `T.M'
. W
3
Number of bedrooms (if residential): .
•
Total daily Bow (residential -compute 0 150 gal. her bedroom): Ct
'I•opography: ( I Flat ( I Rolling ri Steep Slope % of Slope
Soil Nature: I )and r I Loam I I Clay I Other /Depth: MAY ®6 1997
TOWN OF QuEL-NS6URV
Ground Water: at what depth? feet BUILDING AND CODE
Bedrock or Impervious Material: at wha depth? feet
Percolation•J•est: [ Not Required I 1 Required/Rate min. per inch
Domestic Water Supply: r( 1' Municipal 1. I Well 1 1 Other
If domestic water supply is a WELL: water supply from any septic absorption is feet
PROPOSED SYSTEM:
�l �� ��
Septic tank Poo gal. (minimum size: 1.00(1 gal.)
'file Field: each trench feet. / total system length feet.
•
Seepage Pit(s): number of / size each: 1ft. x ._ ft.
• Size of stone to be used: # / depth or thickness • feel.
IHOLDING TANK SYSTEM: (if required)
Number of tanks: • Size of each: gal.
•
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 oft/re Code,of the Torn of
Qucenshury, any permit or a pproval granted which is based upon or is granted in reliance upon
any matericrl misrepresentation or failure to make a material fact or circumstance known by or on
behalf o fan applicant, shall be void.
I have read the regulations with respect t its application and a re to abide by these and all
requirements o f the Town o f Queerrsbr y ,S rnilary Sewa e Di, rdinance.
Signature of'responsib'e person:r C' l• 1)ates`� 2?
TOWN OF QUEENSBURY
- -- - BUILDING & CODE ENFORCEMENT
531 Bay Road
Queeesbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM IJSPECTION
Name W L`� UPJY>'►'LCAnr\ - 0 t�
l - 11` n
Location _0G___, x QO* sa
Date 5 -—(a •Pf 7Permit #9t-- � �"
SOIL TYP . a m-Clay-
Results of Percolation Test-
(if applicable Rate'-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD Total Length
Length of eachr nch
Depth of trencihes
Size of ston 1
SEEPAGE PIT . Numbbr-
Size - ; ft. ti ft.
Stone size
PIPING: Size Type
Bldg. to Tank gc4Ta:2
Tank to Dist. Box II w
Dist. Box to • i ac P‘1(3
Openings Sealed? es Partial
LOCATION/SEPARATI .
Foundation to Tank ' f et
Foundation to Absorption 2t7r feet
Separation of Pits 5 feet
Conforms as per Plot Plan `e )e---
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Fro t - RP r Left Side - Right Side
fiddle Front - Middle Rear
SYSTEM USE APPROVED: NO
Arrive. •-�
Depa ed: AM `-
ffY ��
Bolding IT:p•.for
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