1990-527 CERTIFICATE OF COMPLIANCE
• \JOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date November 13. 19 90
This is to certify that work requested to be done as shown by Permit No. 90-527
has been completed.
This structure may be occupied as a sow9gv nit craticrt
Seelye Rd, Cleverdale
Location
•
JOHN SCHMULBACH
Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. 6c Code Enforcement
• • ,„. , „ • ' • . _ , ,•
BUILDING PERMIT
TOWN OF QUEENSBURY No 90-527
WARREN COUNTY, NEW YORK
ro
PERMISSION is hereby granted to JOHN SCHMULBACH O
OWNER of property located at Seelye Road, Cleverdale Street, Road or Ave. rn
in the Town of Queensbury,To Construct or place a
Sewage alteration c_n
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
3 Silver Maple Drive
Clifton Park NY 12065
0
2. CONTRACTOR or BUILDER'S Name x+
A.C.I. Builders
3. CONTRACTOR or BUILDER'S Address
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
L+]
CD
N
6. TYPE of Construction—(Please indicate by X) (D
u r�
( )Wood Frame ( 1 Masonry ( )Steel ( ) _
7. PLANS and Specifications iD
No. Sewage alteration to include 188 feet of tile field at variable length as per
plot plan, and application.
8. Proposed Use
Sewage alteration
rn
CD
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Au• st 1 3 19 92
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the CD
town of Queensbury before the expiration date.) ¢'.,
CD
Dated at the Town of Queensbury this i-1 1-1-h. Day of , Aug ist 19 90 ¢*
SIGNED BY -•'--e2=0� for the Town of Queensbury
Building and Zoning Inspector
`# � ,r (;l TOWN OF QUEENSBURY
104 APPLICATIDrJ FOR SEPTIC DISPOSAL PERMIT
DATE: g/4 .ot,N G 11MENSBURY
'RECEIVE
LOCATION OF PROPERTY FOR INSTALLATION De-G Gy 990
Owner's Name: -ct.1 ,ti ,D4//wcuG/3. /4
Address: Sj i4 V e & 9p, KEPT.
��-mac: � ,�,�. ('t 2�`j'o�,r �.��t� ��j 2ec:�R
Installer's Name: ,9 1(-f. At rLim/aS Telephone: 4'5G•_ 'Z7
Number of bedrooms (residential only) Z
Total daily flow. (compute @ 150 gal per bedroom)
Topography: Circle one: Flag Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: not required equired
Rate - Min. Per Inch e COL j6..e
Domestic water supply: Circle one: Municipal Well Other L- ' c 4
If domestic water supply is a. well :
Separation: Water supply from any septic absorption dab feet.
PROPOSED SYSTEM: Septic Tank //40. 2 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length 4 feet
VK t�F- may-TK
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. /Depth or Thickness feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal.
*Alarms system and associated electrical work to be inspected by an approved
agency.
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: e h4� DATE: g/l 0 4
A_Y21_, 1/Xij' /.)
.�our // f�
n o Q ,.,,
BUIL s ING and ZONING DEPARTMENT
Bay a d Haviland Road, R.D. 1 Box 98
O eensbury, New York 12801
SEPTICI DISPOSAL SYST INSPECTION
NAM / / _ik_ c)C• /(l// 4//71L/
LOCAT1O il // / . r . {% 7
/ . . -, ' ,
DATE 7//0/ (' PERMIT O. /
/ s .- �
SOIL TYPE - .and - Lo.m - Clay Jam/
Percolation est Requ.red? YES - NO
Percolation ;ate - Ni, /Inch - /
TYPE of\ /ST
SY
Absorption\ fi'ld, to al length
Length of eac tren /
Depth of trenc. es /
Size of gravel`: /
SEEPAGE PITS-R .er'of)
Size- ft. \ ft.
Gravel size , \
PIPING: N;\ Size Type
Bldg. to tank ',/
Tank to dist. bo . \
Dist. box to fie 'd,pit \
Openings sealed? YES ENO Partial
LOCATION/SEPARATIS S: \
Foundatio7 to tan } ft.
Foundat'on to abs., tion ft.
Absorp /ion to lot A ne ft.
Separ tion of pit_; ft.
LO ION OF SYST -' O PROPERTY(circle. ne)
Fr t - Rear - Le•t ....de - Right side -
C ENTS:
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SYSTEM USE APPROVED YES `174
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OWN OF QUEENSBURY
RECEIVED t i
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10 1990
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BLDG. & CODE DEPT,
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