98-275 CERTIFICATE C)1� COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
[late August 27 ig 98
98275
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 _—.-
Location 9 HUGHES COURT
Owner
KINGSLEY , DUANE & DOROTHY
_
TAX MAP NO . 114 . - 1 - 6 By Order of Town Board
( O ,` F M
U"
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE s 0 TOWN OF +QUEENSBURY No 98275
TAX MAP NO . 114 e — 1 - 6 WARREN COUNTY* NEW YORK
PERMISSION is hereby granted to XINGSLEY r DUANE & DOROTHY
OWNER of property located at
9 HUGHES COURT Street. Road or Ave.
at the Tao of Qution i ra
To Construct or place a SEPTIC ALTERATION
at the above location to accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Oueensbury Building and Zoning Ordinance.
t. DWNERS Address isHUGHES COURT
QUEENSBURYr NY 12804
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3_ R SWft'i BUILDERS Address
<. ARCHITECTS Name
S. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by Xi SEPTIC
{ } Wood Frame ( } Masonry ( I Steel I I
7. PLANS and SRecificttions
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
No,
a. proposea Use
SEPTIC ALTERATION
25 May 22 2000
$ PERMIT FEE PAID — THIS PERMIT EXPIRES
19
(If a longar period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Ciwansbvry before the expiration dmaj22 may 1
Dated at the Town of Oueensbury this
IIff NEFDavrqt49
f
for the Town of 4ueensbury
SIGNED BY
Buitdir+g and 20 Inap+eeor
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury i Permit No. _
Dept_ of Community Development
Building & Codes Office
Fee Paid $ '
742 Bay Road
Queensbury, NY 122804
Location of property for installation:
Property Owner's Name: .�___ ., ^- �,I �7 /a S"r
Property owner's Mailing Address: �.. c7' 1:3 z l ,�/
Installer's Name: �rc�-c.._% / Phone # aj� �Y �s'
Number of bedrooms (if residential): Total daily flow:
(residential - compute '& 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope MAY
�.. eep _
Soil Nature: sand, loam, clay, other I depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? , feet
Percolation test: T not required, required [ rate min. per inch ]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank: ` gallon (minimum size: 1 ,000 gal.)
Tile field: each trench =6� feet J Total system length: c2�' feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: J depth or thickness g _Aef feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Harm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to section 136-29 of the Code of the Town of Queansbury, any Permit or
approval granted which is based upon or is granted in refiance upon any material misrepresentation or failure to make a
material fact or circumstance known by or on behalf of an applicant, shell be void.
I have read the+ regulations with respect to this application and agree to abide by these and all regmre+memts of the 'Town of
Queensbury Sanitary Sewage Disposal Signature of responsible ;z
person: tr' �' Date: r
1
TOWN OF QUEENSBURY
BUILDING S CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-825+6
SEPTIC DISPOSAL SYSTEM INSPECTION
Namei
Location
Date�-7 �� Permit #�`"l `�-7
SOIL TYPE : Sand- Loam- Clay-
Results of Percolation Test-
( i applicable ) Rate-Minute/ Inch
TYP F SYSTEM:
ABSORP FI Total ength
Length o trench
Depth of tr es
Size of s ne
SEEPAGE TS : ber-
Size fto x ft .
ne size _
PIPING: Size YPe
Bldg . to Tank
Tank to Dist . Box
Dist . Box to Field/Pit
Openings Sealed? Yes 0 Partial
LOCATION/SEPARATIONS : feet
Foundation to Tank feet
Foundation too Absorption feet
Separation of Pits
Conforms
OCATION OF S P
SYSTEM ON
la
L PROPERTY :
No
( circle one )
Front - Rear - Left Side - Right Side
Middle Front -
C Middle Rear
,I COMMENTS: C�e .
/Jyj ,�l.41y�
I,
SYSTEM USE APPROVED : YES NO
Arrived:
Departed:
Building ns —
07 Bare $aan or oetaf v6% ar o a r a ca ffq
all ob*ft Such as hommms ala116 60M 11111111161111116 Me.e
shown on this dotmin& 1 also 1t Mat 1 hm
personll«11�I nllaaslfol�d dilri oas set %a ow so d ovam:p
SKMTURE DATE
PILOT Pr4v
SEPTIC SYSTEM
Notice : The following statement must be " stamped" on your plot
plan . This sheet of paper may be used for purposes of drawing your
plot plan . After drawing such plot plan , please read the statement
and sign it * if you choose to use other paper for your plot plaza ,
the office will stamp those plans for your signature .
TOWN Of QUEENSBURY BUILDING DEPARTMENT
f k compliance with our corrimnts shall
foot be corn uuml os indicating the !
plans and specftaWns are in full
Compliance with the code.
l
FILE CCPY ,�- � �
MAY 22
�A CLrv-\
N
TOW
_ . . .
T]ATE ff/
TOWN OF QUEENSBURY
BUILDING 9 CODE ENFORCEMENT
742 Bay Road
Queenshury NY 12804
(51$) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 14f ��bl V% _
Location 9 H 13GyAr- LS Cflr, }L�'T
Date J;7� Z=&, 1`t�' Permit #
SOIL TY E. ands oam-Cl ay-
Resul is of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM: i
ABSORPTION FIELD : tal L gth
Length of each tren
Depth of trenches
Size of stone
SEEPAGE PITS : Numb er-
Size - ft . x I __..._.
Stone size
PIPING: Sze Type
Bldg * to Tank x1i C'TVaratia
40
Tank to Dist . Box
Dist . Box to Field/Pit ��
Openings Sealed? c'" r�~ o
LOCATION/SEPARATIONS :
Foundation to Tank I D -vfeet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan -"Yet:
___ -
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rear - Leff 5i� Right Side
M1 d d 1 a Front <E:Xj:ddl e Ream
COMMENTS :
l SYSTEM USE APPROVED: YES <
Arrived :
Depa -
Wilding ryVpfc r
• f VW w ww.WWWO wrW WWWWW i air WNIUMMM U16
all ob*ft sad m bmsk Wd4 tu% fmms6 Ma„
shown CO "" doevn"at 1 slant 0 - Od 1 how
personally d t ad fwm sm the ."
DATr r r_r E
FEOT PI AN
SEPTIC SYSTEM
matice : The following statement must be " stamped" on your plot
plane This sheet of paper may be used for purposes of drawing your
plot plane After drawLng such plat plan , please read the statement
and signs. it . If you choose to use other paper for your plot plan ,
the office will stamp those plans for your signature .
e
rAjf
'C'7a
(?
MAY 2 2 1998
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