97-331 CERTIFICATE =0 COMPLIANCE'
TOWN OF QUEENSBURY
COUNTY, NEW 'YORK
Date June, 7 h ' ' 19 .q-1, .
- Rgli
- ,.
. .
" J 97331
This is to certify that work -requested to be done a's shown by Permit No.
has been completed.. . -
This structure may; be used as "a ,
SEPTIC ALTERATION
Location 23 i1OORW OOD DR.
.
Owner ROOF GEORGE & ;LIZABETH _ fi A,,,,,
'• i
By Order of f Town Board «" ' `1
TAX MAP NO. `6. . -1-9. 2 TOWN OF QUEENSBURY. 4•'l,'`
.(-3atiffe__506---""""m"-7.i;b" .:;'4,,If- •. :.
. . . ' "'silt ' --
- ' Director of Building & Code Enforcem c
'
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BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 97331
TAX MAP NO. 76 . —1-9 . 2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to POOP, GEO.R & ELIZAB-ETH
OWNER of property located at _ 23 MnnRWnnll DR. Street,Road or Ave.
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. OWNER'S Address is
23 MOORWOOD DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
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
set°r.ic ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ • 25 PERMIT FEE PAID —THIS PERMIT EXPIRES June 23 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 Queensbury this 23Day of June 19 97
SIGNED BY Se for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Tovi+n of Queensbury Permit No. ! 3 j
• Dept. of Community Development
Building&Codes Office (�0
742 Bay Road Fee Paid
Queensbury, NY 12804
Location of property for installation: ea3 HD ► 6v.
PropertyOwner's Name: Crd-y-y<____ ® � JUN 2 3 1997
_ Property Owner's Mailing Address: 2- P oof ry a 7
Installer's Name: C./Au 17#V U G C,./ Phone # 7 ? - 7 o),.
• Number of bedrooms,(if residential): 3 Total daily flow:
(residential -compute @ 150 gal./bdrm.)
Topography: kflat, rolling, steep slope % of slope
• Soil Nature: Q(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 I
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 ® gallon (minimum•size: 1,000 gal.)
Tile field: each trench. feet / Total system length: ' feet
Seepage pit(s): number of / size each: P ft. by P ft. •
Size of stone to be used:_# 3 / depth or thickness 2 feet
• HOLDING TANK SYSTEM:. (if required)
•
Number of tanks: Size of each: gallons
Alnrza syst=and associated electrical work to be inspected by a certified agency.) •
For your protection, please note that pursuant to Section 136-29 of the Cods 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 as applicant;shall be void.
I have read the regulations with 'cation and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal iyd
//
___ 2/27
Signature of r person:rson: 1 - (7. Date:
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name jQcc}
Location ( j nYUJ()() 1
w
Datib—e-9-
SOIL E: n lay-
Results of Percola ''on Test-
(if applicable) R. - Minute/Inch
TYPE OF SYSTEM:
ABSORPTION_ FIEL►. . . gal Length
Length of each t ne.
Depth of trenc e: -
Size of sti e
SEEPAGE PITS: umber-
Size - ft. x ' ft.
Stone size -5 L"" t___
PIPING: Size Type
Bldg. to Tank aC?
Tank ,to Dist. Box _H - -
Dist. Box to Field RbDP�?Zj
Openings Sealed? es No -arts' l
LOCATION/SEPARATI •
Foundation to Tank �C- feet
RINFoundation to Absorption feet
�aration of Pits feet
onforms as per Plot Plan tkkii. No
LOCATION OF SYSTEM ON PROPERTY:
(ci rcl
Front - Left Side ht S di e
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived: 1�Zir3
Depart: : fiR,VPP
$11p:wilding I sp.. tor
TOWN OF QUEENSBURY
BUILDING" b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL. SYSTEM INSPECTION.
NameF__C)PIGEE_ i:/ 0.0‘)
Location 77, t4bRp4AmSOD Der
Date 2_ Permit # G7-3'31
--6\—SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Tes
PP
(if applicable) Rate-Minufe/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: : .1 Length
Length of each t
Depth of t -nche• .
Size of ston:
SEEPAGE PITS: 'limber-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Ta ,
Tank to Dis . Box
Dist. Box is Field/Pit
Openings S:aled? Yes No Partial
LOCATION/S PARATIONS:
Foundatio to Tank feet
Foundatio to Absorption feet
Separatio- 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:
;\
.C)q0.C.C)
SYSTEM USE APPROVED: YES NOh..VI "
Arrive- . ;As
Depa ed I E_
�' Bui l di nb spector
„ ,, _?Cif
,..._a e'...” U,L 9 ,..,_3(..31
1®p,TE
JUN .22 1997
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