96-724 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
November 21 96
This is to certify that work requested to be done as shown by Permit No. 9.c72_4_
has been completed.
This structure may be used as a SMPTIr AT.TRR4TT.cM
Location 57'2 }.JOON rrTr.r. RD
Owner or?H5r-#Y, E;T.TZABETH REGAN
By Order of Town Board
TAX HAP NO. 44 . --2- 37. 2 TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 96724
TAX HAP NO. 44 . -2-37 . 2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to ORMSBY, ELIZABETH REGAN
OWNER of property located at 1639 MOON HILL RD. 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
R. D. #1 BOX 1639
LAKE GEORGE, N.Y. 12845
2. CONTRACTOR or BUILDER'S Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDER'S Address
JAY SWEET MOBILE PHONE#744-0028
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction-(Please indicate by XI
SEPTIC
( ►Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
SEPPBC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 PERMIT FEE PAID -THIS PERMIT EXPIRES November 19 19 98
$ (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
19 November 96
Dated at the Town of Queensbury this
Day of fg
SIGNED BY for the Town of Queensbury
Building and Zoning In ctor
Application for !SEPTIC DISPOSAL PERMIT o
SPAMI' RECEIVED
VET) Z
Location of property for installation: 7� I' 1 I t\ i t 0
T �
Owner's Name // 0 rhas H 'l RMIT NUMBER
Owner's Mailing Address: 3 kt L i_ .
YIl:l: t'n[U g 5.ti
Installer's Nantc: -&to ling w�^ Phone # 7 "
� C
Number of bedrooms (if residential):
Total daily flow (residential -compute 0.1) I50 gal. per bedroom): c
Topography: ( )S)flat ['I Rolling [ � Steep Slope g;, of Slope
Soil Nature: I Al Sand n Loam r -1 Clay n Other -/Depth:
Ground Water: at what depth? feet
Bedrock or Impervious Material: at what depth? feet
Percolation'I'cst: f] Not Required I J Required/Rate min. Ix•r inch
Domestic Water Supply: I I Municipal I >CI Well I I other
If domestic water supply is a WELL: water supply from any septic absorption is feet
prrEYPD
PROPOSED SYSTEM:
NOV 191996
Septic tanit./e ) gal, (minimum size: I.000 gal.)
T ivt'='Of QtiE:,,.:BBURY
feet-
s Z Y'jjll-DING AND CODE
Tile Field: each trench feet_ / total system length dell-DING
Seepage Pit(s): number of / size each: ft.x ft. •
Size of stone to be used: # G- / depth or thickness 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.
bar your protection, please note theft pursuant to Section 136-29 of the rode oldie Town of
•
Queenshury, any permit or a p proi'al 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 o fan applicant, shall be void.
•
1 have read the regulations with respect to this application and agree to abide by these and all
requirements o fthe Town of Quee,tsburCy Sanitary Sewage Disposal Ordinance.
Signature of responsib'e person: — il.j �y� Date: I I— / r/- -
-4 ,J2
--`� TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 0,a56 e'
Location _`1ld4.) ,LtlL� /46•
Date ///7.r//7 4 Permit # ?6' 7214
SOIL TYPE: Sand Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To 1 Len /5 2
Length of each teen 1
Depth of trencheA '
Size of stone ` :2--
SEEPAGE PITS: N ber-
Size - t. x ft.
Stone size
PIPING: Size ej-��,"�
Bldg. to Tank f�+
Tank to Dist. Box �i SA,, g;;--
Dist. Box to Field/P.
Openings Sealed? ' Yes No Partial
LOCATION/SEPARATI .
Foundation to Tank ° feet
Foundation to Absorption feet
Separation of Pits eet
Conforms as per Plot Plan r' Yes No
LOCATION OF SYSTEM ON PROPER4:,,
(circle one)
Front - Rear - Left Side Right Side)
Middle Front - Middle Rea ,,
COMMENTS:
�
•
SYSTEM USE APPROVED: I YES NO
Arrived: ! .
Departed: /�� _F
Building Inspector