1999-085 • •
Certificate of Compliance
Town of Queensbury
Warren County,New York
March 26 99
Date
.99085
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
13 WHIPPOORWILL RD.
Location
Owner REYNOLDS, DAVID J.
TAX MAP NO. 82 . -5-37 . 23
By Order Town Board
TOrE,QUEENSBUi
Director of Building&Code Enforcement
BUILDING PERMIT
TOWN. OF QUEENSBURY
VALUE" $ 0 No. 99085
TAX MAP NO. 82 . -5-37 . 23WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to REYNOLDS, DAVID J.
OWNER of property located at 13 WHIPPOORWILL RD. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATION
at the above location in accordance to applicationtogether 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 .
13 WHIPPOORWILL RD.
QUEENSBURY-, NY 12804
2. CONTRACTOR or BUILDERS Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 ...LOWER" WARREN " STREET -
QUEENSBURY,. .,NY. 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) . -
SEPTIC
( )Wood Frame ( 1 Masonry ( 1 Steel" • ( )
7. PLANS and Specifications
SEPTIC ALTERATION. AS PER. PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25"" PERMIT FEE PAID —THIS PERMIT EXPIRES" March- 25 19 2001
(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 Queensbury this 25Day of March 19 1999
SIGNED BY for the Town of Queensbury
Building and, oning Inspector
•
'ti w
r Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. T --ogS
Dept. of Community Development
Building &Codes Office - Q�
742 Bay Road Fee Paid 0 ,
Queensbury, NY 12804
.Location of property for installation: r 3 °'l i pi rr l.,o _ (f/',�v t.
Property Owner's Name: _(!�- t.,,v' 2 C /l,O Cif ..
U
Property Owner's Mailing Address:
Installer's Name: Til),, c4, "00 T, Ci Phone # 2 9r- ,f-/9 'I
Number of bedrooms (if residential): 3 Total daily flow: (f C2
(residential - compute @ 150 gal./bdrrn.),
Topography: )( t, _rolling, steep slope % of slope r=`
Soil Nature: sand, loam, clay, other /depth: MAR 5
1999 •
Ground water: at what depth? et / Bedrock or Impervious Material:TQ et
/f / BUILDING ANDppE
Percolation test:!` not r •' ed, required [rate min. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. _
PROPOSED SYSTEM
Septic tank/tbOO gallon.(minimum size: 1,000 gal.)
- Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of r/ size each: . ft. by K ft.
Size of stone to be used: # J / depth or thickness / feet
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: i Size of each: gallons
I
Alarm system and associated electrical cork to be inspected by a certified agency.
J
For your protection, please note that pursuant to Section 136-29 of the 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 failure to make a
material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: ( Date: K-
D:vic)Q. •
TOWN OF QUEENSBURY •
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name cI\k\ (\
Location \ �1ff(i\ rLO, LL KI
Date --6'-aG),5C\ Permit FAR- 0 5
SOIL TYPE:/ Sand Loam-Clay-
Results of Percolation est-
(if applicable) Rate- %mute/In h
TYPE OF YSTEM:'
ABSORPTIO • H , is T%tal Leng _
Length of each tre -
Depth of trenches
Size of stone
SEEPAGE PITS: mber-
Size - x ft.
Stone size -
PIPING: • Size Type
Bldg. to Ta , %.
Tank to Dis . Box ;5 „_ 4D
Dist. Box to Field/- ' ) h ' V
Openings Sealed? Yes No Partia
LOCATION/SEPARATION .
Foundation to Tank feet •
Foundation to Absorption I feet
Separation or Pits eet
Conforms as per Plot Plan Ye No .
LOCATION OF SYSTEM ON-PROPERTY:
Front
rcl
F -r . Left Side Right Side
Middle Front - , ear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived: ��
Departed: '\ . 03 (2ty.
Building Inspector
f,
TOWN OF QUEENSBURY BUILDING DEPARTMENT TOWN OF Q ,EENSBURY
Based on our limited examination,
a.t pliance 1 41 0 ,, ; BUILDING & a. " PT.
•t be construed as indicating the •
• ns and specifications are in full i
impliance with the code. REVIEWED BY
DATE �J
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