97-311 •
t.
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
a
• Date June 13 19 97
3011 97311
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SII P IC .ALTERATION
• This structure may be used as a
GS HELEN. DR.
Location
Owner HORGAN„ Jc IN & CYNTHIA
TAN €,� �_- No9c} _ By Order of Town Board
TOWN OF QUEENSBURY
2..144/7 ,_,
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97'111
TAX MAP NO. 90. -4-74 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HORGAN, JOHN & CYNTHIA
OWNER of property located at 59 HELEN DR. Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATTnN
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
59 HELEN DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDER'S Address
JAY SWEET
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
SERRIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES June 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.)
12 June 19 97
Dated at the Town of Queensbury this Day of
SIGNED BY d)42. for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No. _p t
Building &Codes Office 6 O
742 Bay Road Fee Paid %9 _S.
Queensbury, NY 12804
_ ./
Location of property for installation: q- Nat fL) (DV,
Property Owner's Name: ( / . 7 ,,-- __ a,L) o rl e f1
Property Owner's Mailing Address: / 1-7/2 4. 0 v L +J e,
Installer's Name: eu p e_ tus; k Se t,J e_y- Phone # 7 9- oZ 3 e y g/
Number of bedrooms (if residential): Total daily flow: d 6J
11 (residential - compute @ 150 gal./bdrm.)
Topography: )' flat, 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: not required, required [rate min. per inch]
Domestic water supply: k' municipal, well, other I R P C 'E I V E O
If domestic water supply is a WFTJ., water supply from any septic absorpti)n is JUN •lPe1997 _
PROPOSED SYSTEM T01(i'1 O �;i��E`,°;, ; 1Y
BUILDING AND UODE
Septic tank: /o o a gallon (minimum size: 1,000 gal.) ,
Tile field: each trench C e ' /Meet I Total system Iength: S? feet
Seepage pit(s): number of / size each: .ft. by ft.
Size of stone to be used: #.5 / depth or thickness /4 a 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.i
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 Sanitary Sewage Disposal Ordinance. ;�
Signature of responsible person. \c .e1� Date: C // - Ty
//
30
TOWN OF QUEENSBURY G�r
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 42644/i
Location a,fLe '-i
Date (p /(4 2 Permit # 3 //
SOIL TYP Sand. . oam 1 . -
Results of Percola ,'on T�st-
(if applicable) Rat• to/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: ' otal Lepgth
Length of each tr nch , • 4ftA,
Depth of trenche
Size of stone iZi
SEEPAGE PITS: u ber-
Size - ft. x ft.
Stone size .�
PIPING: S'ze Ty e
Bldg. to Tank O
Tank to Dist. Box 0
Dist. Box to Field/ 6� q
Openings Sealed? Yes No Part' 1
LOCATION/SEPARATIO •
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPER
one)
ront Rear - Left Side - Right Side
• e Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: 111, NO
Arrived: l� 6-U0
Departed: ' y
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Building Inspector
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