97-624 •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date C?(7.1-na,pr 19 q
30q
97624
This is to certify that work requested to .be done as shown by Permit No.
has been completed.
• This structure may be used as a SEPTIC z: f; TT }7
Location 87 MAIN ST.
Owner KEL LEY, C}EFFREY
TAX
Order of Town Board
TAX MAP NO. 129, -1-15 TOWN., OF Q ENSB Y• .
Director 'of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 97624
TAX HAP NO. 129.-1-15 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Kh:j.jtEY, JEFF.EY
OWNER of property located at 87 MATN ST: 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
6 FOSTER AVE..
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. ARCHITECTS Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC.
( )Wood Frame ( I Masonry ( )Steel
7. PLANS and Specifications
>.'•SEP Tit-ALTERATION.:..AS :.PER,PLOT.,PLAN :SPECIFICATIONS a._.
8. Proposed Use
ZySEPTLC.Y,-ALTERATION.,;.,,,,.
$ PiERMIT"EEE PAID -THIS PERMIT EXPIRES ' ,:.• - October- 22 19 99•k:•„
(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.)-
. 23r , d� October-... 19
Dated at the Town of Queensbury this Dad of . 97_
SIGNED BY. for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. / "+-
Dept. of Community Development l
Building&Codes Office
• 742 Bay Road Fee Paid $
Queensbury, NY 12804 " --
- F411
Location of property for installation: tfr� r-T� 7
Property Owner's Name: TQP g'/f �J ,,,,�Q UEiD N 3BU R'
Property Own ' Mailing Address• Atet--E-
_ /
Installer's Name: if- 796U V Phone # / 9 c - 7 26-q
'. Number of bedrooms (if residential): 3 Total daily flow:
(residential -compute Q 150 gal./bdrm.)
Topography: . flat, rolling, steep slope % of slope
• Soil Nature: ak.sand, loam, clay, other /'depth:
•
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: el.__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 '0az gallon (minimum,size: 1,000 gal.)
Tile field: each trench <CO feet / Total system length: 7,6 ' feet
• Seepage pit(s): number of q / size each: 9ft. by ft. •
Size of stone to be used: # : / depth or thickness / feet
• HOLDING TANK SYSTEM:. (if required)
Number of tanks: • Size of each: gallons
(Alarm
system and associated electrical Rork 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 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 circmnostaace known by or on behalf of an applicant;shall be void.
I have read the regulations with to this •• ' : ••, and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Dispo • .
Signature of responsible person: Date:
/[3o
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT /2,�
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ''` Ili Kf) 1
Location _ '(� ,� SiL
Date 1 o — I ,TT Permit-# -7^ (o -
SOIL TYPE. an.- oam-Clay-
Results of Percolation Test
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: I
ABSORPTION FIELD: o..al Length
Length of each tr=, ch .0
Depth of tr- ches - t
Size of stone
SEEPAGE PITS: Nrunit7.
Size - ft. . ft.
Stone size
PIPING: Size Type
Bldg. to Tank " 13% Le
Tank to Dist. Box 411.61
Dist. Box -to Field/Pit -
Openings <<
Sealed? No Partial
LOCATION/SEPARATIONS:
Foundation to Tank 7sa3 feet
Foundation to Absorption 3!--) feet
Separation of Pits _
Conforms as per Plot Plan o
LOCATION OF SYSTEM ON PROPERVgt
(circle one
Front - ear - Left Side - Ri-_ght Side
Middle Fro - diddle Rear COMMENTS:
SYSTEM USE APPROVED: . YE ,10
Arrived:
Departed:
BAlding I sp tor
, , r
,,
Fill COPY
%)
,-., ,LL
, ,
..,
;,
J
O A F
O
z
Boy-
p®si
1.
if `- r—e) '
‹ ,
/69 ' -.' ''
„ a' Ir ' - + 0 i
1 have seen or ,
aii objects such a;li�� ' �WO on this doh � 0
shown
:, ally '1TOWN OF QUEENSBURY BUILDING DEPARTMENT
2 i ! _ ?'a — Based on our limited examination,
DATE Based
with our comments shall
` $t , I:r' :� not he construed as indicating the
plans and specifications are in full
compliance with the code.
`5 of,fl tr)S rP P)Fl ' S B UR .-�P
u ;ter „ rr .,i DF }i 6pi91 1
BURI.
t VIEVv'ED BY —