1999-743 CERTIFICATE .OF COMPLIANCE .
TOWN Or QUEENSBURY
` WARREN COUNTY, NEW YORK
• Date December7 ' 19 99
99743
N
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This is to certi y that work requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION
• . This structure may be used as a
'QJ SPRUCE COURT --
Location
LILLEY, DONALD & -MAU,tihTd
' , Owner
TAX MAP NO. 114 . -6-1 ‘ By Order of Town Board
TOWN OF QUEENSBURY
. , (-----7)
Director of Building & Code Enforcement •
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 9 9 7'1 3
TAX MAP NO. 114 . -6-1
Permission is hereby granted to T,TLLEY, DONALD & MAUREEN
Owner of property located at 0 SPRUCE COURT
in the Town of Queensbury,to construct or place a SEPTC ALTERATION.
at the above location in accordance to application together withplot plans ana other information hereto filed and
approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
0 SPRUCE COURT
QUEENSBURY, NY 12804
Contractor or Builder's Name:
• - SANITARY SEWER
Contractor or Builder's Address:
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
• Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID-THIS PERMIT EXPIRES December 6 2001
(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 T of Queensbury this 6 Day of December 19 9 9
SIGNED ---- for the Town of Queensbury
Code Enforcement Officer
•
Application for Permit—Septic Disposal System
I Town of Queensbuly 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
� - Office Use
Location of installation: 0 p(Luc�. y��/ EE
Tax Map No. / / I File Permit No.
^� • Fee Paid
Owner's Name: JJ 0 A-CD i-1 L L e vJ
Address: 0 J rP f(/Gg CT
2. INSTALLER'S NAME : 1.7 fie 4)ex-- 044 PHONE NO.7 2-"7 `r7
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom() and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
• 1980 or older x 150 gallbdun = SO (" \!FD
1980— 1991 x 130 gal/bdrm = _
1991 —present. x 110 gal/bdrm = DEC n 1999
Garbage Grinder Installed yes / no P1.- B111LL�i►�G
Spa or Whirlpool Installed yes / no a its r2OE
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
(FED/ ASP at what depth at what depth druwicinaN
Rolling loam feet feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation T st:_ (To be completed by licensed professional engi!wer or architect)
Rate: �,�' 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: ' ilfr14,gallon (min. size 1,000 gal)
Tile Field: each trench //A 4 . Total System Length: S 5' fl. (� �' �d2
�ft
Seepage Pit(s): number of Ai 14"
size of each: — ft. by
Size of Stone to be used: Il / J f'19 / depth or thickness feet
•
Bed System Size: _ x
•
Alternative System: • length and/or size
6. .. HOLDING TANK SYSTEM; (if required)
Number of tanks: / 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 rpspfct to this application and agree to abide by these and all
require n f the Town of QuSensplury Sanitary Sewage Disposal Ordinance.
ignature of respo ible person ate
IIPPI
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT 3*LQ)1(2°--)
742 Bay Road
Queensbury NY 12804 ® l/)
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ( \e L; \ \
Location D ,. k l"Sa --CCW. ��'' c 22
Date �— Permit # q - 7 L/J
SOIL TYPE Sa -Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch /
TYPE OF SYSTEM:
ABSORPTION FIELD: To = Length ► 9,6u
Length of each trent h `. . i'+.
Depth of trenche
Size of stone IL-r02&i-6a'
SEEPAGE PITS: Numter-_/
Size - "\,__ ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank x/57/(.kC.)
Tank to Dist. Bo *zi 500k-z-S---
Dist. Box to Fie d/6 "
Openings Sealed No . :Partial
LOCATION/SEPARA IO .
Foundation to Tfank. /.feet
Foundation to 4bsorption feet
Separation of Pipits eet
Conforms as per Plot P1 an Yes No
LOCATION OF SYSTEM ON PROPERT :
(circle one)
Front - Rear Left Sid Right Side
Middle Front - iddl. ,eat'
COMMENTS:
SYSTEM USE APPROVED: ill
NO
Arrived:
Departed:
e(2
Building Inspector
,* 99743 114 . -6-1
LILLEY, DONALD & MAUREEN
0 -SPRUCE COURT
"I have seen or observed, or believe I saw evident‘, SEPTpr ar.T AVMPI! objects such as houses, wells, trees, fences, etc.,
;hewn on this document. I also represent that I have
e onally measur d distances set forth on the diagram."
%;)43 - ' / ,,
p,f ,�n/F SIGNA E DATE
LJct., 0 u' 1999
TUsF,i\i"Us'-Uu E S6URY
BUILDING AND CODE
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WN--.0V5Z1U---ffralRY BUILDING DEPARTMENT _
Basel on our Fmited examination,
- compliance with our= nenb shall
not be construed as indultiig the
plans and specifications are in MN /\
compliance with the code. ,5"-0
TOWN OF QUEE RY d;c m
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BUILDING & °T
'4 REVIEWED BY /
k Nei
-4 DATE 12-)(Q l
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