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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 F3 TOWN OF QUEENSBURY x No. 94-400 WARREN COUNTY, NEW YORK ro z 0 PERMISSION is hereby granted to HARRIS BAY YACHT CLUB INC OWNER of property located at Cleverdale Street, Road or Ave. � I N 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 x PO Box 139 > Cleverdale NY 12820 H 2. CONTRACTOR or BUI LDER'S Name �C FC 3. CONTRACTOR or BUILDER'S Address n x y n t1 4. AffXX XaVS Name Ctv Engineer: Haanen Engineering 5. ARCHITECT'S Address n H (D 6. TYPE of Construction—(Please indicate by X) C r; ( )Wood Frame ( ) Masonry ( I Steel ( ) F-' 7. PLANS and Specifications No. Septic alteration to include holding tank system (engineered) as per plot plan, specifications and application. 8. Proposed Use Cn Septic system ( commercial) lizl N- 0 $ 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' (D town of Queensbury before the expiration date.) N Dated at the Town of Queensbury this 27th Day o July �g 9 4 O 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 IQ 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