94-697 CERTIFICKYE OF
COMPLIANCE'.
TOWN OF QUEENS@URY
WARREN COUNTY, NEW YORK .
Da to 1. arch 15, 19 j 5
This is to certify that work requested to be done as shown by Permit No. 94-697
has been completed.
Septic. Aiterati.on
This structure may be used as a
Location Cleverdale Rd
Owner Margaret Schroder_ 5 Wineling Rd; Delmar, NY 120
By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 94-697
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to E. Ward & M. Schroder
OWNER of property located at Cleverdale 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 n
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. ¢1
sr
1. OWNER'S Address is
5 Winding Rd
Delmar, NY. 12054 0
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2. CONTRACTOR or BUILDER'S Name O
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W
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3. CONTRACTOR or BUILDER'S Address LQ
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( ) Steel ( )
7. PLANS and Specifications
No. Septic Alteration as per plot plan specifications Cn
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8. Proposed Use rt
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Septic Alteration
0
25 . 00
12/6/95 19 95 p
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the I�
town of Queensbury before the expiration date.) O
Dated at the Town of Queensbury this 6th Day o December 19 94
SIGNED BY for the Town of Queensbury
Building and Zoni nspector
O
Application for SEPTIC DISPOSA � . _4 's� WT STA R CEIVED�
OV 1994
Receii,edo
Location of property for installation: Z_r ,(2A&4F 92, h0vin Of
/ / /54 2 - i q %,4,nsbary A)
Owner's Name �� Gt/Af'1J ��• �G�f/�Q(�O/-ram -`PERKIr'I'tNUMBEII
i
Owner's Mailing Address: �� �
FEE PAID
Installer's Name: a-, Phone #:
Number of bedrooms (if residential): 3 /v
Total daily flow (residential -compute @ 150 gal. per bedroom):
0
Topography: MFlat Rolling 0 Steep Slope % of Slope
Soil Nature: 0 Sand 0 Loam Q Clay 0 Other /Depth: SLfti•f+'%'Actin/Ri�T
Ground Water: at what depth? GT /'dG!lVf7 feet
Bedrock or Impervious Material: at what depth?/r' t feet
Percolation Test: Q Not Required F521 Required/Rate min. per inch
Domestic Water Supply: 0 Municipal 0 Well 0 Other 4,411r f
If domestic water supply is a WELL: water supply from any septic absorption is feet
/I/6 TIC.' l/yR/9 �•PAi✓T�rG' 2 j iiJo vsrrY,���2 9
PROPOSED SYSTEM:
Septic tank: //)ten _gal. (minimum size: 1,000 gal.)
Tile Field: each trench feet. / total system length feet.
Seepage Pit(s): number of / size each: /Z ft. x —ft.
Size of stone to be used: # ` / depth or thickness feet.
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gal.
Alarm 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
Queensbury, any permil.or approval granted which is based upon or is granted in reliance upon
any material misrepresentation or failure to matte 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 Queensburyy Sanitary Sewage Disposal Ordinance.
Signature of responsible person: �'%=�{��n�� � �G . dc&y,- Date: //"Z57'-}11
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
NameGc--\,Ny "�0 G
Location CAc.\ 1\(� Q, P,\L
Date - �0- Permit # 4
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length _
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS.: Number- �
Size - ft. x ft.
Stone size _ 3
PIPING: Size Type
Bldg. to Tank '`_ �.
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank /0 feet
Foundation to Absorption _�v feet
Separation of Pits � eet
Conforms as per Plot Plan Yes' No
LOCATION OF SYSTEM ON PROPER
(circlOront
Front - of - Right Side
Middle - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: VES NO
Arrived: b IY6
Departed: 6,
Building InspeeUr
v c u lar -�raffi c over QnkS
iZ! Inom.
�Cl1C I ti-
Sei Ieve; c
�` shed s�t�ne
OLrT[C,
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Notes
- \v'eCtherprao gox to v ,--epaT_a,-e
�O.J 1tr, vie a'd�GuY)o�mr r, rd j!4n►1�4+p _
5eParate GlrcuIt fl'SV source requ,red _212-lr-
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-�n house.
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i -ce
REVIEWED BY _
CY c I,.;1 V.
61TE �1
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V"t1In I :^c.L1oil
'ier ;suer
GY'c1Sf - r F?
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DRY VVELL
/7 r
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- Eight -fit O.D. Dr (4 Wet i
yr �Aiej I Clove
non era H � c
t'r0..i -!T, 1 C b e o `f' ; ;
- tt oove r car L M i i r or eQ ! ll,
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1.
Ipvc
outlet
Set level or
cr ushed e- e —
D1 %ftd5 `R 1 8 Ij T ION of
UEDe FoPz-rM«LE,K cr equ�v
T E 5 T
:* 1- o- z" 5t on e 4 d U st
-z,16"Coar3e Sand
i6 -53' M ed red Sa fi
-- 53-9I-- Med anc ;Tjx z0°fo clad
- Roofs o 48it
2 _ o _ ?« TOP 3 01 1
7-5+' INA cd, red sand
5+-96" aM e c� 5a nd me x 20'a c1r��
Root 5 to 6 0"
as Shown i ig
tGt ate'
m
N 0 T E_:
NOTE:
-A H 0djaCert CY)d -second adjacent pry pertie,5 on if ake water - 5etbocks meL
Trar n 1 C beam bearmq
D r V We,' I 5 ae ke
V
501
Force
D
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j Area
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DW H c)
Barn -
_j
rage
LLJ
51 ht ffl as
ant to p e r (1 .3
to naturo-1 grade
- ReMove Lan �anks nknownI 9 u
I 'eale� wa'eackfy)6 device - sand J_)a,,,kfj I
- All tanK4 boxioints S L
ertioKt.
- Toilets - I m5 90.1./f lush (r, Orn.). 5hower heaps _t'aucet5 ,O qpm mav
- 3ewer ine 51 Ope YV per 5o! lid
- Force main +,o "have con'LMUOU5 slopeIL I , i
E Faces belou-) -Frost.
- 5Ketch from 6ee6 descri ption �iejdnne'
as"rernen-L5 not a 5urve
IN
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10, BUIL"
REVIEWED BY
7 ff�: 0=4,d I
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DATE 'A , AS
ne er i nq Detat Is
ON - -51TE 5EWAGE 5Y5TEM
WISM