97-274 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Mav 29 19 97
97274
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be used as a SEPTIC ALTERATION
location 1269 BAY RD.
Owner HARNEY, MARION S . --
TAX ["HAP NO. 28, -1-30 By Order of Town Board
0 TOWN OF Q EENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97274
TAX MAP NO. 28. -1-30
WARREN COUNTY, NEW YORK
HARNEY, MARION S.
PERMISSION is hereby granted to
1269 BAY RD. Street,Road or Ave.
OWNER of property located at
SEPTIC ALTERATION
in the Town of Oueensbury,To Construct or place a
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.
t. OWN �s�§dd .s RD.
LAKE GEORGE , NY 12845
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. CON3 ClifftlE13,)ILDERS Address
0
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
( )Wood Frame ( )Masonry ( )Steel ( 1
7. PLANS and Specifications
SEUIC ALTERATION AS PER APPLICATION
8. Proposed Use
SEPTIC ALTERATION
25 May 29 99
$ PERMIT FEE PAID -THIS PERMIT EXPIRES /9
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
29 May 97
Dated at the Town of Queensbury this Day of 19
SIGNED BY cQJY\. t i" ( �. 1 for the Town of Queensbury
$ding and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. 7 d_ f
Dept. of Community Development
Building &Codes Office r-J�
742 Bay Road Fee Paid ' ).,
Queensbury, NY 12804
—7
Location of property for installation: / ( q `I 7;0
Property Owner's Name: v tg D ) I cc r '1
Property Owner's Mailing Address:/ „Y J�
Installer's Name qe ,mod s-2 r( 7sty).tom,. Phone # 7 q23 c/r
Number of bedrooms (if residential): o? Total daily flow: S c7)
(residential -compute @ 150 gal./bdrm.)
Topography: X flat, rolling, steep slope % of slope
Soil Nature: sand, p loam, clay, other /depth:
Ground water: at what depth? feet I Bedrock or Impervious Material: at what depth? _ feet
Percolation test: X 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 /i feet.
PROPOSED SYSTEM
Septic tank 6,-07 gallon (minimum size: 1,000 gal.)
Tile field: each trench 3-7 feet / Total system length: oL 4-- .0 feet
MAY 2 81997
Seepage pit(s) number of / size each: ft. by ft.
Size of stone to be used: #f'2- / depth or thickness /0 /7 &Ult_ I N G ANC CODE
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(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 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 respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: retie , Date: S'
•
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Ia
Name 9X66491/740/j//j/
Location 8 4 -
Date 5-4 07 Permit # z,
SOIL TYPE: Sand Loa Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tot Length /
Length of each trenc i
Depth of trenches
Size of stone
SEEPAGE PITS: m er-
Size - f x j ft.
Stone size
PIPING: Si h T pe
Bldg. to Tank /l1
Tank to Dist. ox a
Dist. Box to Field/Pi y
Openings Sealed? lip No Partial
LOCATION/SEPARATI$ r,
Foundation to Tank ` et
Foundation to Absorption 7 feet
Separation of Pits feet
Conforms as per Plot P1 an al No
LOCATION OF SYSTEM ON PROPER vir
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rea
COMMENTS:
() - ����a-►low - D 1K
SYSTEM USE APPROVED: YES NO
Arrived: /d S 5�
Departed: /(^05
Building Inspector
C.
TOWN OF QUEE'NURY ,„,t
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