97-688 CERTIFICATE O1! • COMPLIANCE
TOWN OF QUEENSBURY
- WARREN COUNTY, NEW -YORK
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Da to RtrwuA phg,r 1 R _ 19 97
• 301 . a
This is to certify that work requested to be done as shown by Permit No. 97688
has" been completed.
This structure may be used as a SEPTIC ALTERATION
Location 29 HELEN DR.
•
Owner POSTERS -GARY & CARLENE
By Order of Town Board . •
TAX MAP NO. 90. -4-89 : TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING 1 PERMIT
TOWN OF QUEENSBURY
VALUE : $ 0; - • No 97$88;"
TAB MAP NO 90. -4-89:.. WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to POSTER. GARY. & CARLENE
OWNER of property located at 29 HELEN DR. 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. OWNERS Address is .
:29 HELEN DRIVE
v"= 1 QUEENSBURYr, NY•,-:-12804
•
2. CONTRACTOR or BUILDER'S Name.
I.-B.S. SEPTIC=
3. CONTRACTOR or BUILDERS Address-
2: LOWER, WARREN STREET.,.
�.<QUEENSB IR 4 .N,y., :;,r12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) p,
( I Wood Frame ( I Masonry ( I SteeiP E `�'IC
7. PLANS and Specifications -
SEPTiL't ALTERATION,AS, -PER PLOT. PLAN:WSPECIEICATIQNSm ,_
8: Proposed Use
•* ,,.SEPTIC-, ALTERATION.,:.
$ �� ��? .2:5 . :` PERMIT FEE PAID —THIS PERMIT EXPIRES 3s'311I
(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.) p
- { k
Dated at the Town of Queensbury this -'18 Da of -•November--: •1g r x 97 - �° --: '
SIGNED BY `i for the Town of Queensbury
Building and Zoning Inspector
. H
Application for SEPTIC DISPOSAL PERMIT O
STAMP Itl'sC:1:IVl l)
•
.._..._....,) 7._ .i. (cA. 1 p.: to,(.....,
ill" 0
l.ocalion of property for installation: 44 +1
Owner's Name 6-6,r Li /7&5' .'C r PERMIT NUM
Owner's Mailing Address: #(� / Ye_e_ ." c rl''C- A 740 ,+J
tri
Z
PAID
Installer's Name/jr I. S P p 1 iel— phone #: )2D 'O /9 4( FEE MZM
W
Number of bedrooms (if residential): ry
Total daily flow (residential -compute cn 150 gal. per bedroom): T✓e 0 jcA..„ L
Topography: I Flat rl Rolling El Steep Slope % of Slope
Soil Nature: I ) ( Sand , Q Loam/VA
oam/V Clay 1-1 Other /Depth:
Ground Water: at what depth? ./ feet
Bedrock or Impervious Material: at what depth? feet
Percolation'I'esL: [t Not Required r1 Required/Rate min. per inch
Domestic Water Supply: I X I Municipal rJ Well { Other Q
If domestic water supply is a WELL: water supply from any septic absorption is //�`) feet
. �'' , z
PROPOSEDSYSTEM: I trN 1`"'' ' '4 -�
Eb-t'-‘G'-----
Septic tank? NOV 1 8
gal, (minimum size: 1.000 gal.) 1997
'file Held: each trench feet. / total system length fecT
1 .D11\?G Ach BODE
Seepage 1'it(s): number of / size each: r ft. x ft. y `
Size of stone to be used: # / depth or thickness t. - feet.
HOLDING TANK SYSTEM: (if required)
Number of tanks: • Size of each: ' gal.
Alarm .system and associated electrical work to be inspected by a certified agency.
For your protection, please note drat pursuant to Section 136-29 oldie 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 faaihtre to ma/ce a material fact or circumstance known by or on
behalf o fan applicant, shall he void.
I have read the regulations with respect to this application and agree to abide by these and all
requirements of the Town o f Qncensbury.' airy Server a Disposal Ordinance.
/// r
Signature o f respon sih'e person:( �, Date: ,—1?
QUEENSBURY
OF TOWNi o r9
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYST INSPECTION
Name C CA; \
Location . / QA \n v.-L..-
Date l g 7 Permit # 7--6g
SOIL TK'-E: and- am-Clay-
•
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: .tal Length
Length of each tre ch
Depth of trenches,.
Size of stone
SEEPAGE PITS: Numbe` - ? -
Size - ft. .x ' cc'- ft.
Stone size
PIPING: Size . Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Fiel- I% p,1/45 C__
Openings Sealed? Yes ,)No Partial
LOCATION/SEPARATIONS:
Foundation to Tank n05V_ feet
Foundation to Abso feet
Separation of Pits •- _ feet
Conforms as per Plot Plan <I, -No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Fron = Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrive .
Depar ed . \,
Build' g nspector
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