94-400 CERTIFIC FE ;jj. COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Mav 26 19
This is to certify that work requested to be done as shown by Permit No. 94-400
has been completed.
This structure may be used as a septic system (commercial)
Location Cleverdale
Owner Harris Bay Yacht Club Inc,
10-1-110 l By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY x
No. 94-400
WARREN COUNTY, NEW YORK ro
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PERMISSION is hereby granted to HARRIS BAY YACHT CLUB INC
OWNER of property located at Cleverdale Street, Road or Ave. �
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in the Town of Queensbury,To Construct or place a Septic alteration
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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
x
PO Box 139 >
Cleverdale NY 12820
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2. CONTRACTOR or BUI LDER'S Name
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3. CONTRACTOR or BUILDER'S Address
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x
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4. AffXX XaVS Name Ctv
Engineer: Haanen Engineering
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) C
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( )Wood Frame ( ) Masonry ( I Steel ( )
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7. PLANS and Specifications
No. Septic alteration to include holding tank system (engineered)
as per plot plan, specifications and application.
8. Proposed Use
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Septic system ( commercial)
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$ 35 . 00 PERMIT FEE PAID—THIS PERMIT EXPIRES July 27 19 96 >
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rl'
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town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this 27th Day o July �g 9 4
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SIGNED BY r for the Town of Queensbury
Building and Zoningtl ctor
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid ®
Date: 7/22/94 Reviewy
LOCATION OF .PROPERTY FOR INSTALLATION: HARRIS BAY YACHT CLUB JUG 19 W
HARRIS BAY' YACHT CLUB INC. Toy,� �d J
-Owner' s Name: of
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Owner' s Mailing Address: P . O.. BOX 139 RT. 96 , CLEVERDALE `ANY g1� 20
TO BE DETERMINED
Installer's Name: . Phone #:
Number of bedrooms (if residential ) : N/A
BLA.CKWATER ESTIMATED
Total daily flow (residential-compute @ 150 ,gal . per bedroom) : FROM 100 TO 500 GAL/DAY
. Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth: N/A
Ground Water-At What Depth? 0-5 Feet
Bedrock or Impervious Material-At What Depth? UNKNOWN Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other _LAKE
If domestic water supply is a well -
Separation: Water supply from any septic absorption N/A feet
H:OLDI:NG TANK SYSTEM `UE BELOW
PROPOSED SYSTEM: Septic Tank gaol . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness feet
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks 4 Size of Each 12 50 Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON () • DATE: ZS
A 4-
W. /g4Gi
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �' ' S �" 0� UrJ
Location "F` '
Date y%I 9)� Permi t
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/ nch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Len th
Length of each ench
Depth of trenche
Size of stone
SEEPAGE PITS: Num er-
Size - ft. ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pi
Openings Sealed? es No Partial
LOCATION/SEPARATIONS
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plo Plan es No
LOCATION OF SYSTEM N PROPERTY:
(circle one)
Front - Rear - Left Side - Right ide
Middle Front - Midd a Rear
COMMENTS:
SYSTEM USE APPROVED: nYESNO
Arrived:
Departed: /
Building Inspe for
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Location
Date &Z"i Permi t # a�
SOIL TYPE: Sand- oam-Clay-
Results of Perco ation Te t-
(if applicable) R to-Min to/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length
Length of each tre ch
Depth of trenches
Size of stone
SEEPAGE PITS: Numb
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Fiel Ye
Openings Sealed?. Ye No Partial
LOCATION/SEPARATI S:
Foundation to Ta k feet
Foundation to Ab orption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SY M ON PRO ERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front Middle Rear
COMMENTS:
LrQT� �✓ r�G P'�
j�
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building a or
T0WN OF QUEENSBURY
BUILDING g CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name / •!'S �C �
Location
Date ja, Permit # y®o
SOIL TYPE: and-Loam-Clay-
Results of ercolation Tes -
(if applicab e) Rate-Minu /Inch
TYPE OF SYST
ABSORPTION FI •LD: Total ength _
Length of each trench
Depth of trench s
Size of stone
SEEPAGE PITS: N ber
Size - _ ft x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Fiel /Pi
Openings Sealed? Y s No Partial
LOCATION/SEPARAT ONS:
Foundation to T nk feet
Foundation to sorption feet
Separation w" its feet
Conforms as p Plot Plan Yes No
LOCATION OF S STEM ON PRO RTY:
(circle one)
Front - Rear Left Side - ight Side
Middle Front - Middle Rear
COMMENTS:
ze, -
0
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
r
Building Inspector
TW OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Day Road
Queensbu ry NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
1
Date Permit # --
SOIL TYPE: Sand- oam-Clay-
Results of Percol tion Te t-
(if applicable) Ra a-Minu a/Inch
TYPE OF SYSTL34:
ABSORPTION FIELD: T tal ength
Length of each trenc
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes o Partial
LOCATION/SEPAR,ATIO, -:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pit feet
Conforms as per P of Plan es No
LOCATION OF SYST ON PROPERTY:
(circle one)
Front - Rear - L ft Side - Right ide
Middle Front - Niddle Rear.
COMMENTS:
Ut
e 6V\v i ook�3 �u U , �t- -}
SYSTEMUSE APPROVED: YES � ME
1�
Arrived: /mow
Depart
�Q
wilding B s ctor
TOTN OF QUEENSBURV
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM! INSPECTION
Name Vkaq-F%L> C3ALj G�C'�
Location -
Date Permit #
SOIL TYPE: Sa -Loam-Clay-
Results of Perco ation Test-
(if applicable) R te-Minute/ nch
TYPE OF SYSTEM:
ABSORPTION FIELD: T tal Len th
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: JS 'ze Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes N Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorpti n feet
Separation of Pits feet
Conforms as per Plot P an Ye No
LOCATION OF SYSTEM CON ROPERTi�:
(circle one)
Front - Rear - Left S de - Right ide
Middle Front - Middle Rear
COMMENTS: -
e�,1� PL C \C C3k �51 "9.j
L1 eJ�
SYSTEM USE APPROVED: YES O
Arrived:
Depart . J
i ding sp ctor
ELECTRICAL INSPECTIONS
DUPLICATE MUNICIPAL RECORD
Permit No. l D (�,
Owner. /I �'L ,//A/Y ��� 17i0� / rff/S Sj l �yfj
Occupant S"9fy
Location 9L_N
CRY s�ete
Installation as itemized on reverse side has been visually inspected pursuant to applicable Codes.
14.
Installed by
Date Inspector
DLE DEPARTMENT INSPECTION AGENCY INC.
FORM NO.1a EL