97-623 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
• Date 'Ocltoolaor 29 19 97
0-)N <)- 9 1 G 3
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 9 NOW.CtitUP U .
Owner
`i't i-YE3 ik:'I y 3 TAE:-3 ANN
• By Order of Town coard
i-X 14A Nis _ '(.v 1 _ `,__ 1
Director. of Building & Enforcement
BUILDING :,? ERMIT
TOWN OF QUEENSBURY No. 97�
VALUE $ 0 23
TAX MAP NO. 101. —2-21 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
OWNER of property located at 9 NORTHUP DR. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC AT TERAdT/ON.
at the above location in accordance to application together with plot plans an otner information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
MARIE: 9 NORTHUP DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAN DRELLOS. PO BOB 224
GLENS FALLS NY 12801 .
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( 1 Wood Frame ( ) Masonry ( I Steel
7. PLANS and Specifications
:SEP:T ALTERATION A:.SPER PLOT PLAN SPECIFICATIONS.
8. Proposed Use
TIC=ALTERATION..u;
$ PERMIT"FEE"PAID "THIS'PERMIT''E`XPIRE October4:v22 ,- .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.) i
Dated at the Town of Queensbury this '.:i- -`'2.2 `FA'Day of,-�-1 ...00tob.e 9?. ,->}
•
:
SIGNED BY C1461'
for the Town of Queensbury
: Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit NA 7 C7-
Dept. of Community Development
Building&Codes Office
742 Bay Road Fee Paid $ ,d
Queensbury, NY 12804
• °� J
•
Location of property for installation: /�D v �
y� �
Property Owner's Name: () - U11 " /ci Ark/ J ®c79 ,
T
Property Owner's Mailing Address: �/ /u-4 b��U�r��� ;.r %r
)
Installer's Name: C/ A N l T Phone # `? `?ck-
Number of bedrooms (if residential): J Total daily flow: ��D
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
II
•
Soil Nature: 04 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]
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 tOOD gallon (minimum,size: 1,000 gal.)
Tile field: each tench 672 feet / Total system length: .2 `� feet
•
Seepage pit(s): number of / size each: ft. by ft. •
•
Size of stone to be used: # 2- / depth or thickness ( feet
•
• HOLDING TANK SYSTEM:. (if required)
Number of tanks: Size of each: gallons
&lean system and associated electrical work to be inspected by a certified agmoy.) •
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 .= to , : application sad agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Dispo:' • • . .. -. J
Signature of responsible person: Date: / d ?-`72
1Z�
i TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name reY-A-‘2474../
Location
Date .X 4 Permit #
SOIL TYPE: (.and; Loam-Cl ay-
Results of Percolation Test
(if applAcable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION\FIELD: T t 1 Length 7 t
Length of eab tren h
Depth of trenches 2
Size of stone
SEEPAGE PITS: ber-
Size - ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? o Partial
LOCATION/SEPARATIONS:
Foundation to Tank TESW5 feet
Foundation to Absorption Won feet
Separation of Pits _ feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear -r - . - Right Side
Middle Front Middle Rear
COMMENTS:
SYSTEM USE APPROVED: Cl NO
Arrived: `
Depart . o
4
'ld Inds ec r
.,--..
ii _
q 7_ 6;213
I RECEIVED
)cti .1 OCT 2 2-1997
o ; TOWS,OF ':dcs -a_'•';uF7 RY
s
O
In Q Cl
r
1-----Ii
A��?„,
"{hove seen or obsetvew,or believe I saw evidence of,
Ott objects such as MUSK ,Was,I
hove
ally measured th
shown on this document.1 also teptelienteat t distances tin-the diagram."
L2 — 'd- -
SIGNAT DATE
TOWN OF r ; e r[,;i i; "s o u pZ. y V
BIS H1Dili7