99-143 � -Certificatef Compliance
Town of Queensbury
Warren County,New York
May 14 99
Date
99143
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
94 CLEVERDALE RD.
Location
Owner HAVERLY, NEIL & JUNE
TAX MAP NO. 13 . -3-2 6.
By Order Town Board
TORN j 4 E BU /Y
Director of Building& Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 99143
TAX MAP NO. 13. —3-26 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HAVERLY. NEIL & JUNE
OWNER of property located at 94 CLEVERDALE BD. 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 with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
32 BERSHIRE DR. W.
CLIFTON PARK, NY 12065
2. CONTRACTOR or BUILDERS Name
CRANDALL, CHRIS
3. CONTRACTOR or BUILDERS Address
R.D. #1 , BOX 1376
LAKE GEORGE, NEW YORK 12845
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
I Wood Frame ( I Masonry ( I Steel ( I
7. PLANS and Specifications
No.
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES Apr i 1 19 2001
19
(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.)
Dated at the Town of Oueensbury this 19 Day of Apr i 1 19 1999
SIGNED BY CL. for the Town of Queensbury
Buildi nd Zoning Inspector
02/07/1996 21:00 5187454437 DEPT OF COMM DE',:EL ir'
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury .
Dept. of Community Development Permit No.C ( —, L ,
Building Bay &Codes Office
74
742 Bay Road Fee Paid
(36
Queensbury, NY 12804
'
Location of property for installation: _ Cleverdple Road
Property Owner's Name: Neil Haverly
Property Owner's Mailing Address: 32 Brookshire Drive West, Clifton Park, NY 12065
Installer's Name: +0,-0 ' k Phone #
- Number of bedrooms (if residential): ' 5 Total daily flow: 550
(residential -compute n-. ., gal./bd�.)
(See plans) •
Topography: flat, rolling, steep slope % of slope (Water saver fixtures)
• Soil Nature: sand, loam, clay, other/depth:
Ground water: at what depth? feet '/ Bedrock or Impervious Material: at whaRECakifED
Percolation test: not required, required [rate min. per inch] A PR i 6 /R99
Domestic water supply: municipal, well, other 1-OW` OF
€iEEi\ l3t�fY
��lCf
If domestic water supply is a WELL, Waters1�. �fVG OOZE
PP Yapply.from .�,y seudc absorption is feet. ---_.
PROPOSED SYSTNI
(See plans)
Septic tank gallon (minimum size:.. 1,000 gal.)
Tile field: each trench feet / Total.system length: feet
Seepage pit(s): number of / size each: . _ ft.by ft.
Size of stone to be used: # ./ depth or t cloi s feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: • Size of each, gallons
(Alarm system asrl associated electrical work to be inspa.-ted by a certified agency.
For youv protection, please note that pursuant to Section 136-29 of the Cads of the Town of J
bury, any permit or
approval granted which is based upon or is granted in reliance upou any material uriarepreaer aicu or failure to make a
material fact or circumstance km sn by or on behalf of an Applicazat, Shall void.
I bave read the regulations with respect to this a li ;nod by[liege and all reiLire-.r o the Town of
Qneensbury Sanitary Sewage Disposal
zrSignature of responsible person: p 3 q�
Date:
TOWN OF QUEENSBURY
I`
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name iiichm-Rt_y
Location Ccd-OC- 'QA-c-
Date Permit # ` -"1
SOIL TYPE. .nd-Lo."-Clay- `/ l
0 .�
Results of\Percolation Text-
(if applicakle) Rate-Mirite/Inch
TYPE OF SYS1M: /r
ABSORPTION F LD: Total Length PLf-�
Length of each trenc `,
Depth of trenctles
Size of stone ,) i c____LP
__
SEEPAGE PITS: um er-
Size - ;t/ x ft.
Stone size i
PIPING: X Size Type
Bldg. to Tank / \
Tank to Dist. Bpx \
Dist. Box to Field Pit
Openings Seale ? Yes No Partial
LOCATION/SEPA TION :
Foundation tol ank feet
Foundation to'Absorp ►ion feet
Separation of/ Pits feet
Conforms as pier Plot " an Yes No
LOCATION OF YSTEM ON "OPERTY:
(circle one)
Front - Rear Left Side - Right Side
Middle Front - Middle Rea
COMMENTS:
ALA-r'Ztu. Lteo N7— C'.)1• •
SYSTEM USE APPROVED: YES NO
Arrived: _�"
Departed:
Building Inspector
•
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name _A,,v,• etv\
Location \ Qi�oQr:(.)Datec. -42) C Permit
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) R. e-Miiute/Inch
TYPE OF SYSTEM: �
ABSORPTION FIELI : Total ength EEC-& c 4&
Length of each rench ,
Depth of trench:s
Size of stone
SEEPAGE PITS: N mb- -
Size - x ft.
Stone size
PIPING: Size Type
Bldg, to Tank `' p 6;v57i
Tank to [# ►�
Dist. Box to Field P' £z"TO 1' 5c-Aie
Openings Sealed? No Partial
LOCATION/SEPARATII
Foundation to Tank feet
Foundation to Absorption Sc-_& P .v feet
Separation of Pits _ feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERT :
(circle
Front - Rear - 4 eft Sid-- Right Side
Middle Front - Middle Rear
COMMENTS LKA0R-k\A L.] 6e p5
�� (-?31QD . �TEgfKv -0K 7 r-
L+146 5,,-,.qa< - Cl- /23.
(9_,)kfc'2 —OK
/QCc-MCc(C
&c_6-c. -oK 5/iZ/R9 c115
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: --;gb
Building Inspector
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
'anel Board No Cert.N2 6 613 5 Cut-in Card No.
)wner Ati r - j A /C
,ocation 7 7_ C E.
p D,
nstallation Consisting of S' 7,vI2 /e Y Q
2
nstalled By C.; c/ /2 G� Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
ancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
ntroduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of makin pections at any time, and if its
ules are violated,the Company shall have the right to re�j e t't is
)ate � - INSPECTOR 7'�'� ' G
E
Member N.F.P.A.,I.A E.I.
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
•
Name , 4vPv41/
Location c78,i4'
Date 4,/ 4 Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD• Total Length
Length of each ren ,h
Depth of `°trench-s \
Size of stane
SEEPAGE PI : umber-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. :ox
Dist. Box to Feld/Pit
Openings Seal :d? Yes No Partial
LOCATION/SEPA: .TIONS:
Foundation to'Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
toe 164 Sy://'r-
SYSTEM USE APPROVED: YES NO
Arrived: P
Departed:
O/7
Building Inspector