1999-443 CERTIFICATE OF 'COMPLIANCE
TOWN OF QUEENSBURY:
WARREN COUN1'Y, NEW YORK
Date July 21 19 ; 99
99443
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
80 :COUNTRY COLONY DR. —
Location
• PENDERGRASS, TH-IOMAS •&
Owner'
TAX MAP NO 47 . -3-2 By Order of Town Board
TOWN OF QU ENSBURY . .
arm
Director Of Building• &•Code•Enforcement .
BUILDING PERMIT
VALUE $ 0,. .= .:.; WN OF QUEENSBU,RY No 99443
TAX MAP NO. 47 . —3-2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to PENDERGRASS,. THOMAS &
OWNER of property located at 80 COUNTRY COLONY DR 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
• MARYANN 80 COUNTRY COLONY. DR
QUEENSBURY, NY 12804 ,
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
JAY' SWEET .
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel 1 1
7. PLANS and Specifications
No.
8. Proposed Use .
SEPTIC ALTERATION
2,g; July 19_ 20.01
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(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.) -
19 July. :.. .19-. 1999
Dated at the Town of Queensbury this ' Day of
SIGNED BY for the Town of Queensbury
ding and Zoning Inspector
.y 1'
application for SEPTIC DISPOSAL PERMIT
Town of Queensbury C)(� cj
43
'Dept_ of Communiry Development Permit No. "�`
Building &Codes Office
742 Bay Road Fee Paid S ) S. 43‘)
Queensbury, NY 12804
L11
t9
Location of property for installation: 6 C` p v�i 'f��-y �
• / ! JUL 1 9 1999
Property Owner's Name: ..O/14 Q S ?e h c er q ra f
l TOWN OF QUEEN-a?URY
Property Owner's Mailing Address: SC BUILDING AND CODE
• Installer's Name: -,(A 1 . �u V�J .1Q t,jss Phone # I — 0J1'
Number of bedrooms (if residential): _ Total daily flow:
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope , % of slope
• Soil Nature: --sand, loam, clay, other /depth:
•
• Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: )(' not reeuired, required [rate min. per inch]
Domestic water supply: municipal, x well, other
If domestic water supply is a WFT.T, water supply from any septic absorption is /a () feet.
PROPOSED SYSTEM
ARM-
Septic l® a° gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: ,2 £1?) feet
Seepage pit(s):'number of / size each: . ft.by ft.
Size of stone to be used: # 2— / depth or thickness ? feet •
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical work to be inspected by a certified agenRy.
1
For y otn protection, please note that pursuant to Section 136-29 of the Code of the Town of Qoeenstany, any permit or
aypivval wed 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
Signature of responsible person: Date: 7- r P
1,- .111111
TORN OF QUEENSBURY
BUILDING 8 CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C a C1.2 )IThoala
Location C „� C 011` )r
Date - Permit #C2\ + —443
SOIL TYPE: Sand- oam-Clay-
Results of Percolation Test-
\ (if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: I 777
ABSORPTION FIELD of Le typ `-(()
Length of e tren 50
Detkof enche �
Size of
SEEP E PITS: Number-
Si. e - ft. x ft.
tone size
PIPING: .Sbe Type
Bldg. to Tank ll��
Tank to Dist. Box r+ s(NZ 3-s
Dist. Box to Field/P;_ 4 y
Openings Sealed? No Partial
LOCATION/SEPARATIO ' •
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits eet
Conforms as per Plot Plan Y s No
LOCATION OF SYSTEM ON PROPER � .
(circle one)
Front - Rear - Left Side Right R4d
Middle Front - Middle Rea
COMMENTS:
i�6 • 40 " 6K •
SYSTEM USE APPROVED: YES NO
Arrived: ('b _t
Departed:
Building Inspector
•
4 F---
TOWN OF (7 L .EE` SBURY — .�
BIJ�LDI ya A APT.
\e
REVIEWED r `; _ ` e
DATE '� il �'L4 0 4 .(' .e. .._ et
l.d
FIt F
COPY
dF ,,,,..,_
i
„so 0 7,9—LI93
-----P - ,i-
P NED
lc
JUL 1 9
1999 A
TOWN OF QL,�ENS8URV
l' BUILDING AND pODE_
"I have seen or observed,or believe I saw evidence all objects such as houses, wells, trees, fences, etc., o#,
shown on this d)current. I also represent that I have
•
personally measured the dist- a
ant• set forth on the diagram."
0 ,
Wel SIGNrTURE � — f 7
DATE
TOV�tJ�i'Q�, � r
4 BasedOr sntjF{�,. . ,;Ls.?.*..DEP RT" r
on our limited examinant, rAcP�T
compliance with our comments shall
not be construed as indicating the
plans and specific• bons are in full
•
compliance with the Cf;•
t1v.
.