98-777 CERTIFICAT]JO14 01P COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
[late December 22 19 98
98777
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
155 SIG HAY Ra .
Location :.
RUMPF , JEFFREY
Owner
TAX MAP NOo 143 . - 1 - 1 . 2 By Order of Town Board
TOWN OF QUEENSBURY
/ f� S MrJ�A S�Gfi"9i ^
Director of Building 8 Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSIBUR.Y No, 98777
TAX MAP NO . 14 .3 . - 1 - 1 . 2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to RUMPF r JEFFREY
OWNER of property located at
155 BIG HAY RD . Street. Road or Ave.
in the Town of Clueensbury, '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
JEFFREY 155 BIG BAY RD .
QUEENSBURYr NY 12804
2. CONTRACTOR or BUI LEW R S Name
SANITARY 'SEWER.
3. CONTRACTOR or BUILDER'S Address
DAIS DRELLOS PO BOX 224
GLENS FALLS NY 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
S. TYPE of Construction — (Please indicate by x) SEPTIC
f I Wood Frame ( I Masonry l ) Steel I }
7. PLANS and Specifications
SEPTIIC ALTERATION AS PER 'PLOT PLAN SPECIFICATIONS
B. Proposed Use
SEPTIC ALTERATION
25 December 21 1S 2000
PERMIT FEE PAID THIS PERMIT EXPIRES
41t 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.I
21 December 199$
Dated at the Town of Queensbury this Day of 19
SIGNED BY f for the Town of Queensbury
—" Building and Zonrng Inspector
f Application for SEPTIC DISPOSAL PERMIT
Town of Quecaabury of Co Permit No. �R_ 7 r 7
Dept. mmunitlr Devaiopsmeat
Building; & Codes Offico
742 Bay Road Fee Paid S
Queeasbary, NY 12804
Location of property for installation:
I9U dre IL
Property Owner's Name: T e FF /
Property s Mailing Address:
---�
Installer's Name, i! -' Cry— Phone # Y%9c1 '
Number of bedrooms (if residential): Total daily flaw:
(residential - compute a 150 gal./bdrm.)
Topography: �L fiat. rolling, steep slope % of slope -
Soil Nature: tl sand, loam, clay, other I depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth.? � feet
Percolation test; K not required, required ( rate coin. per inch )
Domestic water supply: 7C municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tarda ZOO 0 gallon (minitn m. size: 1,CW gal.)
Tiles field: each trench � � feet / Total system length feet
Seepage pit(s): number of I size each= & by &
Size of stone to be cued: i 1 depth or rt„c ' fleet
HOL I G TANK. SYSTEM: (if required)
Number of tanks: Size of each: gallons
------------
Alszrm "an sad aasoaiated electrical work for be ;respected by a centifzed agtim7.
For Y=x wot wdun, please note tbat puzmaze to Section I34-29 of the Code of'tho Town of Qaeenabciy, nay peamd or
aFFMi l gemmed which is based upcw or is Smat d isa relia a upon any meta dal 5 veamtx6m or &Reno to raako a
mstacW Suet or akcamstmoo known by our ca babnlf of ari eppUca ; abatl hs vudrl.
I have read the rgplsbons with respac sad agxea to abide bf these and aU regwn menu of the Town of
Qoeembury Sauimay Sewage l7*XWA(O
Signature of responsible person: Date• f [7 ! ` {
FIRE MARSHAL
'!-OWN OF QUEENSBURY
QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED ^ .. PERMIT *
NAME
LOCATION q--'
SCHEDULE INSPECTION ON _ A. . T +uTIME
APPROVED
NIA YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS --
EMERGENCY LIGFITING
FIRE EXTINGUISHERS
FIRE ALARM SYSTEM - -- - -
FIRE SPRINKLER SYSTEM - -^
FIRE SUPPRESSION SYST __.---
HOOD INSTALLATION �- -
INTERIOR FINISHES - - - - - ---------- -
I
STORAGE: --- - -
CLEA NCE TO SPRINKLERS
CLEARANCE TO BEATING UNITS -
REQUIRED SIGNAGE - - __-
CHIMNEY - - - -
WOOD STOVE - -- -FIREPLACE - MASONRY - -
FIREPLACE - FACTORY BUILT `
REMARKS: OK TO THIS DATE
4
1NS EE R
M3P]i-1A.'Pt18
OV
TOWN OF QUEENSWRY
BUILDING >x CODE EMPORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Na
Location q
Date - a C ` +per1m [� �)
SOIL TYPE!::]! o - lay_
Results of Percolation Test.
( if applicable ) Rate- Minute/ Inch
TYPE OF SYSTEM:
ABSORPTION FIE Tota Length air-sue,
Length of ac trench 4--�
Depth of t e trench
Depth
Size of St e
SEEPAGE P Numb
Size - f x - ft .
Stone s ' e
PIPING : Sire Type
81 dg . o Tank
Tank Dist . Box LA
Dist . Box to Field/Pit
Openi s Sealed ? r Na P�arti a
LOCATION/SEPARATI I
Foundation to Tank XC�_ feet
Foundation to Absorption - r��feet
Separation of Fits _ eet
Conforms as per Plot Plan
LOCATION OF SYSTEM ON PROPERTY:
( circle one )
Front - RearCZ Left '--,Right Side
Middle Front< a eta
COMP"TS
SYSTEM USE APPROVED: Y O
Arrived-
Depa
Bui d Inspector
i
� Ivn�
TOWN OF QUEEN Y
BUILDING & T,
REVIEWED BY
DATE ]
I
Fseen or obseral, or b*a I sari eridmts such as houses, wells, firer, etc.,
shorm on this documed I also mpresmt *A I haae
personal the discs set Iorth oo the diegrem."
SIGNATURE DATE
n
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