98-759 IF
CER,rIFIC TE 01i, COMPLIANCE ,
TOWN OF QUEENS13URY
WARREN 'COUNTY , NEW YORK
�( i � , Ud t@ December16 lg 973
`�'� 98759
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 210 SUNNYSIDE RD .
Owner NEWELL , ROBIN - -
TAX MAP NO m 54 . -- 6 - 1 By Order of Town Board
T OW,�4, OF ,I�iE SBl_1
Will
Director of Building 8-Code Enforcement
BUILDING PERMIT
VALUE s m TOWN OF QUEEN58URY No ,
TAX MAP NO . 54 . - 6 - 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to NEWELL ROAI
OWNER of property located at
210 SUNNYSIDE RD . Street, Road or Ave.
in the Town of {]ueertsbury,
To Construct or place a _ SEPTI�IR ATION
nd
at the above location in accordance to application together with plot plans and other information hereto filed a
approved and in compliance with the Town of 4ueensbury Building and Zoning Ordinance.
t. OWNERS Address Is
SUNNYSIDE RD .
QUEENSHURXr NY 12804
2. CONTRACTOR or SUtLMfiS Name
I . H . S . SEPTIC
g. CONTRACTOR or SUILOERS Address
2 LOWER WARREN STREET
+QUEENSHURYr NY 12804
4. ARCHITECT'S Name
S. ARCHITECTS Address
6_ TYPE of Construction — (Please indicate by Xi SEPTIC
( I Wood Frame I 1 Masonry ( l Steel ( I
7. PLANS and Specifications
SEPTIBio. ALTERATION AS PER PLOT PLAN SPECIFICATIONS
a. Proposed Use
SEPTIC ALTERATION
2 5 December 15 ti9 2000
$ PERMIT FEE PAID — THIS PERMIT EXPIRES
(If a longer period is rettuired an application for an extension must be made to tfie SuiWing and Zoning inspector of the
ro
town of Oueenskwry before tfta expiration date.I
15 December 1998
Dated at the Town of aueensbury this
pay of
19
SIGNED 9Y _a.�
r e2s for the Town of Queensbury
Building arK1 Zoning inspector
ti
Application for SEPTIC DISPOSAJ, PERMIT
Town of Qtieensbuxy Permit No. S?
Dept_ of Community Development
Building St Codes Office
742 Bav Road Fee Paid S
Queensbury. NY 12804 // f
Location of property for installation: t: n
Property Owner's Name: rr ,--�^ S✓
Property Owner's Mailing Address: 4Td 1 42 {= * /� 00/
Installer's Name: r-.—. / Phone
Number of bedrooms (if residential): _ Total daily flow: 0
(residential - compute 0 150 gal.lbdrm.)
Topography: fiat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other 1 depth:
Ground water: at what depth?,/`-'/T t feet / Bedrock or Impervious Material: at what depth? � feet
Percolation test: not required,
required [ rate c:2 min. per inch ]
Domestic water supply: municipal, �ell, other
If domestic water supply is a WELL, water supply from any septic absorption is e:�d� feet.
PROPOSED SYSTEM
Septic d.___..M gallon (minirr+um size: 1 ,000 gal.)
Tile field: each trench 12 feet ! Total system length: +� ^ feet
Seepage pit(s): number of size each.: . ft. by ft.
Size of stone to be used: # � I depth or thicicness feet
HOLDING TANK SYSTEM: (f required)
Number of tanks: Size of each; gallons
Alarsu systesn and associated electrical voork to be baspected by a certified Wsewy.
For your protection, please note that pursuand to Section 136-29 of the Code of the Town of fueensb+xryv any permit or
approval granted which is based upon or is ,granted iII reliance upon any a- aterld rniarevrescubdion or f &ure to make a
material fact or cavu ustance ]mown by or on behalf of an appUc-ant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and an regLziircramdo of the ToWn of
Qtteeusbsuy Sanitary Sewage Disposal I�E''[..'' / �
Signature of responsible person: e5 Date:
I I.
TOM OF QUEENSBURY VVV
BUILDING A CODE EMFORCEMENT
531 Bay Road
Qu 518-745 MY �4
-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date ? Permi t #
SOIL TYPE : Sand- Loam- Clay-
Results of Percolation Test-
( if applicable ) Rate Min a ch
TYPE OF YSTEM:
ABSORPTI FIELD : To 1 Leng
Length of ch tre h
Depth of tre he
Size of stone
SEEPAGE PITS : Number-_ f t �
Size - ft . x
Stone size
PIPING: Size Type
Bldg , to Tank
Tank to Dist . Box
Dist . Box to Field/Pit
Openings Sealed ? Yes No VartTaT
LOCATION/SEPARATIONS : feet
Foundation to Tank feet
Foundation to Absorption T feet
Separation o` Pits
Conforms as per Plot Plan '��es No
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS :
SYSTEM USE APPROVED : "IE'S NO
Arrived : "
Departed:
�' Building Inspector
»� hove aemt orol�wKorbw lean
�ot a { C
all
shoall � �l d4 m
persontl�y � � �1 � m � �
SIGNATURE �
m `�-
z
tc 7,)j U)
UIC/ CO
m C
q7 S
G We
4
00
}
Torn OF QUEENSBURY
BUILDING !fie CODE ENFORCEWNT
531 Bay Road
Queensbury NY 128G4
518--745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location c16
Date / Permit
SOIL TYPE: ar - - Clay-
Results of�-Percolation Test-
( if applicable ) Rate- Mina ° Inch
TYPE OF SYST
ABSORPTION FI LD : To Length
Length of eac tren
Depth of trench
Size of stone Z�—
SEEPAGE PITS : N mber-
Size - to x Ze
t .
Stone size
PIPING : T e
Bldg , to Tan S
Tank to Dist . Box
Dist . Sox to Field/Pi A
Openings Sealed ? es No Partia
LOCATION/SEPARATION .
Foundation to Tank 30 feet
Foundation to Absorption feet
Separation of Pits _ eet
Conforms as per Plot Plan Ye No
LOCATION OF SYSTEM ON PROPER .
( circle
Front - Rea - Left Side - Right Side
Middle nt - Middle Rear
COMMENTS : j,t
SYSTEM USE APPROVED: YES
Arrived : v2f*5
Departed :
S
Building Inspector
i
TOWN OF NlE S RY
BUILDING A CODE ENFDRCLIT
742 Bay Road :
Queensbury NY 12804
(518) 761-8256
SEPTIC -DISPOSAL SYSTEM INSPECTION
Name
Location
,, ,
Date l y C Permit # J �,► [�`
SOIL TYPE: Sand- Loam-Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total L
Length of each t -ench
Depth of trenches
Size of stone
SEEPAGE PITS : Nr-
Size - t . x ---
Stone size
PIPING: _ Size TyFe
Bldg . to Tank
Tank to Dist . Box
Dist . Sox to Field/Pit
Openings Sealed ? Yes No Part7aT
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
C[ fTS :
► ' ' C
SYSTEM USE APPROVED: YES NO
Arrived : iGi(I
Departed:
Building Inspectbr