97-316 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date June 16 19 97
3a? 97316
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION
This structure may be used as a
Location 17 BARBER AVE
Owner VAN ORM N , IiAt,SEY & FAITH
By� Order of Town Board
TAX MAP NO , t 15 ` _ G.
1 TOWN OF E BURY
c
Director of Building & Cade Enforcement .
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No.
9731G
TAX MAP NO. 115 . —1-5 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to VAN ORMAN, HALSEY & FAITH
OWNER of property located at 17 BARBER AVE. 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 compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNERS Address is
17 BARBER AVE.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
I.B. S. SEPTIC
3. CONTRACTOR or BUILDERS Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
( I Wood Frame ( I Masonry ( )Steel SEPTIC;
7. PLANS and Specifications
SEPtiC ALTERATION AS PER PLO PLAN SPECIFICATIONS ,
8. Proposed Use
SEPTIC ALTERATION ,
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES June 16 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 Oueensbury before the expiration date.)
Dated at the Town of Queensbury this 16 Day of , June 19 97
--7-1
SIGNED BY for the Town of Queensbury
Building and on ng Inspector
Application for SEPTIC DISPOSAL PERMIT
r
Town of Queensbury Permit No. a_7_21j0
Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $0.-S, Li°
Queensbury, NY 12804
Location of property for installation: (' 9f LL--C—t_
Property Owner's Name: ,;%?i 1. v"1 G /— esk,- —_.
Property Owner's Mailing Address: e ="Ci
i,
Installer's Name: jfg �, ,))) Phone # Cr ;;�s,�l
ce �+�•„�"Number of bedrooms (if residential): 5 ',Bull...Doi
Total daily flow: .. C
(residential - compute @ 150 gal./bdim.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what de th? feet / Bedrock or Impervious Material: at what depth? _feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: /) municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. _
PROPOSED SYSTEM
Septic tank: a)gallon (minimum size: 1,000 gal.)
Tile field: each trench 5() feet / Total system length: ?O U feet
Seepage pit(s): number of / size each: ft. by _ ft.
Size of stone to be used: # / depth or thickness 1 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.)
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 to abide by,, = and all " , :..: of the Town of
Queensbury S initary Sewage Disposal Ordinance. /
Signature of responsible person: .,�,•, ( ' A°I.te:
7.----- ‘ 017
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name \JCL y� ov`1' \ E ,ki
Location Y.7 ko, )/00,.A.
Date (,-i1r-97 Permit # C), 2 3l10
SOIL TYPE• and oam-Clay- ,
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: rNicr
ABSORPTION FIELD: Total Le th
Length . each trench
Depth o renches
Si -of one 4C
SEES:..; : S: Number-
Size - ft. x ft.
Stone si-.e
PIPING: iSize Type
4)
Bldg. to ank`
Tank to Dist. Box u •4
Dist. Box to Field/P. u v1
Openings Sealed? No Partial
LOCATION/SEPARATION.
Foundation to Tank /4 feet
Foundation to Absorption ?�( feet
Separation of Pits eet
Conforms as per Plot Plan fp No
LOCATION OF SYSTEM ON PROPER . .
(circle i
Front - ''ear - Left Side - Right Side
Middle Fr. t - Middle Rear
COMMENTS:
C/ ��
•
SYSTEM USE APPROVED: YES 0
Arrived:
Departed: '�
Building Inspector
•
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804 .
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 0/f/ U1e4 li 4 eL
Location j7 4 -
Date 06 97 Permit # 4)?J7A)6
SOIL TYPE: Sand-Loam-Clay- J Xe,
Results__ of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTS ' IELD: Total Length ' _
Length 3f ea•h trench
Dep h o' tre'ches
Size . one
SEEPAGE '. TS: Number-
Size - ft. x ft.
Stone size
PIPING: • Size Type -
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption _ feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear .- Left Side - Right Side
Middle Front - Middle Rear .
COMMENTS:
to
c.7 /00 Cn g,J[) . LU A
I
fits /°6<f&�%
SYSTEM USE APPROVED: YES 60'
Arrived: /e).`/5--
Departed: 7070
Me
Building Inspector
TOWN OF QUEENSBURY •
BUILDING & CODE ENFORCEMENT
531 Bay Road'
Queensbury NY 12804 .4_ , a
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 47 ,��fi9/J
Location /7 .60i5l2 16
Date 4 /6/17 Permit if f?`--3/lp •
SOIL TYPE: Sand-Loam-Clay •
-
Results of rcolation Test-
(if applic bl ) Rate-Minute/Inch
TYPE OF SYSTEM
ABSORPTION FIE : Total Length
Length of, ac trench
Depth of trenches
Size of stOne
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
. Foundation to Absorption _ feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear .- Left Side - Right Side
Middle Front -- Middle Rear
COMMENTS:
//t/e_G-7-- t6e/--rP(,C- --- \.'/'\
SYSTEM USE APPROVED: YES NO
Arrived: , fS'
Departed: , ADP
Building Inspector
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juN •7.6 1997
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REVIEWED i
DATE CD .
. _91, .
EMEr
/ , TOWN OF QUEENSBURY BUILDING DEPARTMENT
�' /a • ,�iItl•
Based on oUr limited examination
compliance with our comments shall
•
t be cstrued as indt the
IA/e 5
plansno and specifications are ining full .
pR
0�.
. complianceon with the codeica,
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q art objects sacb haute
shown o `Is document I '1"'
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