1999-750 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY •-
WARREN, COUNTY,, NEW YORK
Date 19
99750
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
25 LYNNFIELD DR.
•' •
Location
THOMPSON, DANIEL; JR &
Owner
TAX MAP NO. 81 .-1-7 By Order of Town Board ' •
- TOWN F-QU N URY
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. 99750
TAX MAP NO. 81 . -1-7
Permission is hereby granted to THOMP SON, DANIEL, JR. &
Owner of property located at2 5 LYNNF I E7,D nP .
in the Town of Queensbury,to construct or place Enm n LTl R 'PION
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:
ELEANOR 25 LYNNFIELD DR.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
- I .B. S . SEPTIC
Contractor or Builder's Address:
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
$2 5 PERMIT FEE PAID-THIS PERMIT EXPIRES December 8 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 ofQueensburythis 8 Day of December 1999
SIGNED B A)-P� ---...._ for the Town of Queensbury
• Code Enforcement Officer
• Application for SEPTIC DISPOSAL PERMIT ..
•
•
Yowl of Queensbury . -- 75D ,. *
• Dept_ of Community Development • Permit No.
Building & Codes Office e
742 Bay Road Fee Paid $ °
Qu`e.sbury, NY 12804
Location of property for installation. 7--t)
sc - (..3. .....V ,ti N c
i 7 \.1„f_7=,_D
Property Owner's Name: � C //1O/H PSANG. A DEW
Property Owners Mailing Address. C , c C J Q • 1999
Installer's Name: T a /1 (- 5 C,o/ • C �J( 1- phone # C., •i-J { D COm €.
- Number of bedrooms (if residential): Total daily flow: cif 6
(residential - compute @ 150 gal./bdrm.)
Topography: (mot, rolling, steep slope % of slo_ce
- Soil Nature: Asand, loam, clay, other I depth:
���� eP _
Ground water: at what depth/° .feet I Bedrock or Impervious Mates 1at a. what depth? feet
Percolation test:M4 not re it 4, recur e^ [rate min,. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WTI T,, water supply from any septic absorption is feet. -
• PROPOSFD SYSTEM
Cl f/V^-L
Septic ta46O0,gallon (minimum size: 1,000 al.)
Tile field: each trench Cl 6 feet / Total system Iength: )6i-® feet
Seepage pit(s): number of / size each: . ft.by ft.
pro 7Q r
Size of stone to be used: # / death or thiclat sJ feet
H OLDLVG TANK SYSTEM: (if required)
Number of tanks: : Size of each: g1'ons
Cklarrn system and associated electrical worm to be ss c'ted by a certified aggcy.1
For you--protcctien, please note that puisuart to Section 136-29 of the Code of the Town of Qr nsazy, any pemiit or
at;p:-„va1 at which is Eased L?on or is granted in reliance r--. a r erial.sreprese n or lure to make a
/ater a.l fact or c.rnr—ristance known by or on behalf of an applic t, s=ztl be void.
I_have read the reguladons with resi.e.t to this application and awe to abide by these mod all recirements of the Town of
Queer—y Saritary Sewage Disposal Ord ra*+ce
Signat-ure of responsible person: .
Cf -"C..--/-e, Date:�� / •
;. migki
3
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name •
1c)
Location
Date Permit #
SOIL TYP_. San. Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: —�
ABSORPTION FIELD: Total L gt4 901)
Length of each trench
Depth of trenche 0
Size of stone vL t?A c°R
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: „Size Type
Bldg. to Tank C_< `�1 tNG
Tank to Dist. Box a 6oX 35J
Dist. Box to Field/Pit . o `1
Openings Sealed? ' No . :Pa- rta.l
LOCATION/SEPARATION
' Foundation to Tank. T feet
Foundation to Absorption s feet
Separation of-Pits feet
Conforms as per Plot Plan Yes No
LOCATION . STEM ON PROPER •
(circle
Front - Rear Left Side - Right Side
Middle I - Middle Rear
COMMENTS:
•
SYSTEM.USE APPROVED: • YES NO
Arrived:
Departed: ! ` A
Building Inspector
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