97-328 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Da te ,T„r , ,; 19 Q,
97328
This is to certify t a 7 work requested to be done as shown by Permit No.
has been completed.
This structure may be used as"'a SEPT `�LTErtA�:� N
location 3 y ELD AVE.
Owner ' GILF'IAN, ROI3NRT & JP YNL
By Order of Town Board
TAX MAP NO. '1 7 . -6-2 TOWN OF QUE NSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 97323
TAX MAP NO. 117 . —6-2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to GLEN, R$BERT & JAYN-E
OWNER of property located at 23 FFT,D AVE. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a S.E-PTIC 1-FrTE-ATI$N
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 FELD AVE.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
JAY SWEET
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SIEPTIC
( )Wood Frame ( 1 Masonry ( 1 Steel
7. PLANS and Specifications
SEWFIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES June 19 19 99
(If a longer period is required an application(or 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 19Day of June 19 97
SIGNED BY lYQQ,r; for the Town of Queensbury
uilding and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury z
Dept. of Community Development Permit No.
Building &Codes Office QG
742 Bay Road Fee Paid $
Queensbury, NY 12804
f _ J
Location of property for installation:
Property Owner's Name: 1 g e Cc /7 27/
Property Owner's Mailing Address: , 3 --72 fI v JUN 9 1997
Installer's Name: l C e tJ (VI ,c(A)e--Y Phone # ►. !f .1 '�r`lr�co DE
Number of bedrooms (if residential): 3 Total daily flow: ` -L
(residential - compute @ 150 gal./bdrm.)
Topography: V 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: S( 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:/o a U gallon (minimum size: 1,000 gal.)
Tile field: each trench ( !j feet / Total system length: -0-6 feet
Seepage pit(s): number of / size each: ft. by , ft.
•
Size of stone to be used: # L / depth or thickness Z2) c' feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CAlarm 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 pennit 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 • *rrA. �C
Signature Po of responsible person: � J Date:
9/r5°
TOWN OF QUEENSBURY
BUILDING $ CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 6,/e_6*9/1(4./
Locati orr3 /4CieoAkIIPi
Date a(Z3�7 Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Perco a ion Test-
(if applicable)- ath-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION Ft : Tot 1 Lengh1))(A/
Length of each ench
Depth of trenche
Size of stone
SEEPAGE PITS: N ber-
Size - f . x ft.
Stone size _
PIPING: cr�e Type
Bldg. to Tank �G+7 r
Tank to Dist. Box Lk
Dist. Box to Field/° —�
Openings Sealed? No Partial
LOCATION/SEPARATION
Foundation to Tank /feet
Foundation to Absorption _ feet
Separation of Pits eet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPER
(circle one)
Front - Rear - Left Sid - Right Side
Middle Front - Middle R ar
COMMENTS:
Ol
SYSTEM USE APPROVED: I YES NO
Arrived:
Departed: ;) /// +///
V
Building Inspector
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BUILDING Et Ce.,;r4 'S T:
REVIEWED BY • —
• \f'SP 1 :
.\\ DATE _________ d r ,._ _ . co ke_S
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