1999-166 *Wm
1 Certificate of • Compliance
Town of Queensbury
Warren County,New York
Apr 1 22 99
Date
0\ 9 91.6 6
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
18 PEGGY ANN RD.
Location
OwnerSHEARER, MICHAEL & JANET
TAN MAP NO. 90. -6-1
By Order Town Board
TO OF QUEENS U Y
Director of Building&Code Enforcement
_ .
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 99166
TAX MAP NO. 90. —6-1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to SHEARER, MICHAEL & JANET
OWNER of property located at 18 PEGGY ANN 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. OWNERS Address is
18 PEGGY ANN RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
JAY. SWEET
0
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC.
( I Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES Apr 1 22 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.) 2
Dated at the Town of Queensbury this 2-bay of Apr i 1 19 1999
SIGNED BY - Ck2Laljj6,15'.A'
� for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury, 99166 90. —6=1 _
Dept. of Community, •.,, r.SHEARER, MICHAEL & .JANET Permit No. l
Building &Codes Oi:...: 18 PEGGY ANN RD.
742 Bay Road SEPTIC ALTERATION I Fee Paid $
Queensbury, NY 12&,;. -
Location of property for installation: q ��' J/� g/i 2 I
Property Owner's Name: .c�.;��j�
Property Owner's Mailing Address: / p __7 C /Ncv
l�
Installer's Name: (D_,,e--(eetv—c c��— ee�,�Phone # 7-
Number of bedrooms (if residential): 3 Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: 7. flat, rolling, steep slope % C I VE -
Soil Nature: X sand, loam, clay, other / depth:APP 2 1 1999
•
Ground water: at what depth? feet / Bedrock or Impervious It POVEENl y Z, feet
D(NG AND CODE
Percolation test: not required, required [ rate min. per inch ]
Domestic water supply: 3c municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is _ feet.
PROPOSED ASS SYSTEM
Se ik:4,z7J gallon (minimum size: 1,000 gal..)
Tile field: each trench �� feet / Total system length: 2:0-7) feet
Seepage pit(s): number of • / size each: ft. by ft.
Ge-
Size of stone to be used: # 2. / depth or thickness 2 feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CA1 system and associated electrical work to be inspected by a certified agency.
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.
ySignature of responsible person: � Date:
Vill)
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location ' • r‘.
Dat�- '� iA� 06 Permit ir °l -) [Q\p
SOIL TYP andr�oam- -1_ay-
Results of P-rcol .tion Test-
(if applicalle) Ra '--Minute/Inch
TYP' OF SYS EMI:
ABS.'PTION iIELD: Total Length
Lengt • of etch tre'ch
Depth o t -n •- o�
Size of stifle _
SEEPAGE PI 'S: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to T nk
Tank to Di t. Box _ Lit% RN.
-Dist.--Box Field/Pit c. P.}
Openings Sealed? Yes No Partial
LOCATION/SEPA,' TIO
Foundation to Tank --CA/5-1— feet
Foundation to Absorption feet
Separation of Pits f,,eet
Conforms as per Plot Plan - Yes o
LOCATION OF SYSTEM ON PROPERT :
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - M� i-d-UTe Rear
COMMENTS: --�-____
SYSTEM USE APPROVED: ►10-
NO
Arrived: '7
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. iL, k- "I have seen or observed,et'baron I morsvidoes st,
iall objects such as Week Indlettreakblelkillbe
Aeill8SN3110 :10 P rAn'A
4.# ..., ishown on this document i aingleMentillitibilin
6-0 t --> P `"'/' N 1Qessonally measured the-distants Why Se ewe
: 1
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il — S GNATURE DATE
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