1999-741 Certificate of • Compliance
Town of Queensbury
Warren County,New York
December 3 99
• Date
99741
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
LAI INLRES
Location
ROBINSON, EVELYN TRUST
Owner
TAX MAP NO. 69. -3-25
By Order Town Board
TOWKC:TEEN U
•
Director of Building & Code Enforcement
a a• rw•o7
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 99741
TAX MAP NO. 69 . -3-25
Permission is hereby granted to ROBINSON, EVELYN TRUST
Owner of property located at 4 WINCREST DR.
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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
WHITTEMORE, PHILLIP 395 BAY RD.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
JACK HALL PLUMBING & HEATING
Contractor or Builder's Address:
•
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
2 5 PERMIT hE PAID—THIS PERMIT EXPIRES December 3 2001
$ J
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 3 - Day of December 1999
SIGNED BY \IlltIkCIA.A.../-\,-for the Town of Queensbury
• Code •orcement Officer
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: File Permit No.
�9 ---7 V/
Tax Map No. ,q / . 3 / z
/� • Fee Paid CP O
Owner's Name: ..I"� o 8lnf^a-otJ�'
Address: 0 ( /4..) C 5T ,C)�,
2. INSTALLER'S NAME y ( Ply /Js ,4y5i—� PHONE NO. 7 9 7/ `Zl
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Yea of House: No. of Bedrooms x Computation = Total Daily Flow
980 or older V/f x 150 gal/bdrni =
1980— 1991 x 130 gal/bdrm =
1991 —present x 1'10 gal/bdrni = r l C F P\I E
Garbage Grinder Installed yes` / no 4//r o DEC 1999
Spa or Whirlpool Installed yes / no
TOWN OF 0:_; Ls a.',URY
BU(LDIN3 AND CODE
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material D iVater Supply
tat--- l sdn at what depth at what depth unicip�
Ro loam feet feet l
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
• Rate: if/9 minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: CX/5r/ allon min. size 1,000 gal) 0 ,, �y5/Z��P ''� ( e6_,,,,,,, X/5Tl
Tile Field: each trench ft. Total System Length: ft.
Seepage Pit(s): number of 1 size of each: (p ft. by 6 ft. X e
Size of Stone to be used: # 2— / depth or thickness - ( feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number oftanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical,work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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.
Vgft4( /1) /44e,4, 12/3A1
Sign re of responsible person Date
TOWN OF QUEENSBURY
//
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ea5/4theti
Location -17l 4f ve-72CSj / 94, ,
Date /z/3 /r, Permit # cic? 74(
SOIL TYPE: Sand-Loam-Clay-
Results of Percol atybrNTest-
(if applicable) Ra Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: total.ength
Length of each trench -
Depth of trenches /
Size of stone ,%
SEEPAGE PITS: ' NT1 ber-
Size - ft x ft.
Stone size
PIPING: Size Type
Bldg. to Tank - r)
Tank to Dist. Bo)
Dist. Box to Field/P 0Openings Sealed? No Partial
LOCATION/SEPARATION . T1--/ ph i r 0( !j c/6*.'\
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan tip No
LOCATION OF SYSTEM ON PROPERT
(circle •-
Front - Rear - Left Side - Right Side
Middle E- - Middle Rear
COMMENTS: iK cTCi1( Lei- ; Oi2.0 11&-1i
-To C, ,,7-/4)C, 14 /Otc U,ey) wk-cc-
SYSTEM USE APPROVED: 41 NO
Arrived:
Departed: �(��-
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Building i spector
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all obje.c.s Jch ashouses, well,, trees, fences, etc.,
ah-o -- tliis �cument. I alsi •present that I have
oefsonally measure:, P.-• 'istance , set forth on the diagram "
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