1999-714 - • - . _ ., . .• ,
Certificate of • Compliance
Town of Queensbury
Warren County,New York
November 19 99
Date.
•
§9714
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
729 LuzEpkir,' RD.
Location
Owner JARVIS,. LEE & ERNESTINE
TAX MAP NO, 124 . -1-13 . 1
By Order Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 99714
TAX MAP NO. 124 . -1-13.. 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to JARVIS, LEE & ERNESTINE
OWNER of property located at 7 2 9 LU Z ERNE 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.
t. O .SEtlE RD
QUEENSBURY, NY 12804 .
2. CONTRACTOR or BUILDERS Name
TUCKER, PLINEY
3. CreiTR6F6T o liBALddress
QUEENSBURY, NY 128.04.
4. ARCHITECT'S Name '
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC.
( )Wood Frame ( I Masonry 1 "1 Steel (
•
7. PLANS and Specifications
SEPTIC-ALTERATION-.AS PER PLOT PLAN:SPECIFICATIONS
No.
B. Proposed Use
SEPTIC ALTERATION
25_ _ _ . November 18 2001
$ 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 Oueensbury before the expiration date.)
.18 November 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY _. for the Town of Queensbury
uilding and Zoning Inspector.
Application for SEPTIC DISPOSAL, PERMIT
Tower of Queensbury
Dept9• of Community Development I �� 3 , Permit No. ' 7)9
Bui?ei✓g &Codes Office
742 Bay Road
Fee Paid $cp.c
Qu_ersbury, NY 12804
7.2 7 z e✓ e ms
Loeat;on of property for inst2ll2tion:
Property Owner's Name: ,�, _ .J
Property Owner's Mailing Address: NOV 1 1999
Installer's Name: �� ' Phone # l� 'z°"L/4 c}s�r � y
- Number of bedrooms (if residential): 3 Total daily flow: ,S/ „3 6
(residential -compute @ 150 galibdrm.)
Topography: V'flat, rolling, steep slope % of slope
Soil Nature: sand, ,i/loam, clay, other I depth:• _
Ground water: at what de th? feet / B e -ock or Impervious Material: at what depth? feet
Percolation test: not required, required inch[rate min. per - h] _
Domestic water supply: V.-ni:unicipal, well, other
If domestic water supply is a WFT.T , water supply from any septic absorpt:cs is feet.
• PROPOSED SYSTEM
Septic tank• ✓ gallon (minimum size: 1,OCO gal.)
Tile field: each tench ,. 1C7 feet / Total system length: / > '7 feet
Seepage pit(s): number of / size each: • ft. by ft.
Size of stone to be used: # / derich or thickness feet •
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: o locs
CAlarna system and associated electrical work to be inspected by a certified arsr.
For:o z protection, please note that pursuant to Section 136-29 of t`Le Code of the Town of Q.secsbury, any pemrt or
apron al aced which.is based ton or is gutted is reliance t :n anry mq-tPrial m srepresetca or failure to make a
reaterat fact or circumstance known by or on behalf of an appEc,--3, si711 be void.
I have =_ad the regulations with respect to this application and a to abide by these and all: rements of the Town of
Queens :y Sanitary Sewage Disposal Ord aance.
Sig-na:-,Y e of responsible person: `, j �e�� Date: /7//
firc
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEM T
742. Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTI
Name ll
Location j ;c1
Date\\- lcA Permit #CY\-7/
SOIL TYP • Sand-Loam la -
Results of Percolation est-
(if applicable) Rate-M nute%Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total 'Len h
Length of each trench t ``lam
Depth of trenches /
Size of stone /� /
SEEPAGE PITS: Num' err_
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank �� .� $
Tank to Dist. Box • ' (�.C1
Dist. Box to Field/ it
Openings Sealed? Yes No Partial
LOCATION/SEPARATI S:
Foundation to Tanli /D feet
Foundation to Absorption feet
Separation of Pits eet
Conforms as per Plot Plan - No
LOCATION OF STEM ON PROPERT .
(circl o e
Front Rea Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES' NO
Arrived:: to_
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Qyciiwiz�
Location
Date J I—f�j% ermit
SOIL TYPE: an am-Clay-
Results ercolat'on Test-
(if applicable) Ra 'e-Minute/Inch
TYPE OF SYSTEM: I
ABSORPTION FIELD: Total Length
Length of each t ench
Depth of trenche•
Size of stone
SEEPAGE PITS: -N,mber-
Size - \B f . x ‘ t, ft.
Stone size -
PIPING: Size Ty,e
Bldg. to Tank
Tank - �. ----_ • "
D' -:. . - /Pit
Openings Sealed? visum No Partial
LOCATION/SEPARATIii .
Foundation to Tank V;(66,feet
Foundation to Abso ption 2 -jt feet
Separation of Pits feet
Conforms as per Plot Plan Ye No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
r i ddl e Front Middle Rear
6+�9
•
SYSTEM USE APPROVED: 4100P ' A
Arrived:
Dep ed:
Buildin nspect
TCYNN OF QUEENSBURY BUILDING DEPARTMENT
Based on our limited examination,
compliance with our comments shall
not be construed as indicating the
plans and specifications are in tuft
compliance with the code.
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"I lave seen or observed,or believe I saw evidence of,
all objects such as houses, wells,trees,fences, etc.,
shown on this document. I also represent that I have.
pe sonally measured the distances set forth on the diagram."
.��� // /7 to
„� SIG UR DA E
N
N•
4
U
TOWN OF QUEEN UR
BUILDING at de.1b 1A ► PT.
REVIEWED BY ' �,' I
DATE / ;if --‹ N