1999-378 Certificate of • . Compliance
•
Town of Queensbury
Warren County,New York
June 23 99
Date .-
99378
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
4 BARTON PLACE
Location
, HELEN F.
Owner CUTTING •
TAX MAP NO 50. -1-53
By Order Town Board
T QUEANSB7
Director of Building&Code Enforcement
•
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 99378
TAX MAP NO. 50. -1-53, WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to :. CUTTING, HELEN F.
OWNER of property located at . 4 BARTON PLACE 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. OWNER'S.Address is
9 SNUG HARBOR LANE
QUEENSBURY, NY... 12804
2. CONTRACTOR or BUILDERS Name:
QUEENSBURY SEWER
3. CONTRACTOR or BUILDER'S Address
JAY SWEET
0:
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel ( 1
7. PLANS and Specifications
SEPTTC ALTERATION..AS PER .PLOT PLAN SPECIFICATIONS'
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID -THIS PERMIT EXPIRES - June 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 Oueensbury before the expiration date.) .
Dated at the Town of Queensbury this 22 Day of June : 19 1999
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT •
Town of Queensbury (� �_��
Dept. of Community Development Permit No.. `� Ca17
Building &Codes Office Cep
742 Bay Road Fee Paid S
Queensbury, NY 128C4 ( s{ C�� '
Location of property for installation: .5(4. h S RECEIVED
Property Owner's Name: R`Lta,-� C,e,t,�,` ; vtrY . JUN 2 2 1999
TOWN OF C'tLeEENSBtJRY
Property Owner's Mailing Address: tSU H BUILpiNG AND CODE
- Installer's Name: 62..kSe
p�-pti.c ��.— cal � Phone # 7 l ` o� 24 y
. Number of bedrooms (if residential): Total daily flow:
(residential -compute el 150 gaLibdrm.)
Topogaphy: flat, mpg, steep slope % of slope
- Soil Nature: 'sand, Ioam, clay,. other/depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth?_ feet
Percolation test Xs not required, required [rare min. per inch]
Domestic water supply: municipal, A well, other
If domestic water supply is a WELL, water supply from any septic absorption is/6 D feet.
PROPOSED SYSitc12 •
Septc 0 6 u gallon (minimum size: 1,000
Tile field: each trench feet / Total system Iength: feet
Seepage pit(s): number of ( / size each: . R ft.by/ U ft.
Size of stone to be used: # 3 / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tams: : Size of each: gallons
Alarm system aandassociated electrical Rvr$ ac
to be inspected by a certified sgey.1
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Qoeensbury, any permit or
app.vva1 granted which is based upon or is granted is reliance upon any material misrepresentation or failure to make a
material fact or circumstance known by or on behalf of au applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these gad all requirements of the Towa of
Queensbury Sa'i tsry Sewage Dispos .
Signature of responsible person: �e6, Date: — �/
. G' b
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name VNLAN. NAJ (ts
Location 1C�
Date(® Jermit # 3g
,
L
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length _
Length of each trench
Depth of trenc es
Size of stone
SEEPAGE PITS: 'umber-
Size - �; f x b ft
Stone size
PIPING: Size Type
Bldg. to Tank - '
Tank to Dist. Box
Dist. Box to Field/Pi
Openings Sealed? e o Partial
LOCATION/SEPARATION .
Foundation to Tank iia feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot P1 a ----Y\& No
LOCATION OF SYSTEM ON PROPERTY:
(r_' one)
ront>' Rear - Left Side- Right Si e
e Front - Middle Re r
COMMENTS:
p(J////////�/..
l (asszr .^el lie
Ftx i`vrL Sicui.::ee
SYSTEM USE APPROVED: / YE' NO
Arrived: J2%/C�
Departed:
cvik
Building Inspector
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SCALE: One Inch Represents 50 Feet • N
05/03/1999 Produced by the Town of Queensbury, NY, Planning Department
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