99-602 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date September 24 19 99
99602
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 1323 BAY RD. —�
Owner COUNTRYMAN, FRANK & NANCY
TAX MAP NO. 28. -1-28 By Order of Town Board
N .OF QUEE U Y
c / rt/00.,
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 99F0/2
TAX MAP NO. 28. -1-28 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to COUNTRYMAN, FRANK & NANCY
OWNER of property located at 1323 BAY 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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
t. ov v.O. BOX 44506
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
QUEENSBURY SEWER
3. CON,TAACgi4E BUILDERS Address
J0Aj aW �1�
4. ARCHITECTS Name
6. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
I 1 Wood Frame ( 1 Masonry ( 1 Steel ( 1
7. PLANS and Specifications
SEPTIC ALTERATION AS PER APPLICATION
No.
8. Proposed Use
SEPTIC ALTERATION
25 September 21 2001
$ PERMIT FEE PAID -THIS PERMIT EXPIRES .19
(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.)
21 September 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY -�� for the Town of Oueensbury
uilding and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury p ` -'>,l"- 1 , -f' '"� 1, /` ,.I
Dept_ of Communiry Development Permit No. (_���
Building &Codes Office
742 Bay Road S E P '" v 1999 r - ( ,`,
Fee Paid $ 5.
Qu_ensbr, NY 12804
Locaon of property for installation: l .R 7 7)
t,
Property Owner's Name: f`_C( i1 I. C -e' et ‘�+.-1-r 114 cy •
Property Owner's Mailing Address: �r0. er ,,, ., <---(7) i Y€-,,
4 fit` ct-,:c„.A._. Lc �- 1• Installer's Name: LA, F'� � tw � <<,• --� . Phone # 7 7.- . 3 f1 .?'
Number of bedrooms (if residential): ,2, Total daily flow: 3 e 0
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth: —
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: / not required, re uir [rate min. per inch J
Domestic water supply: municipal, ;\ well, other
If domestic water supply is a WFT T , water supply from any septic absorption is feet. _
PROPOSED SYSTEM
Septic tank/v o c gallon (minimum size: 1,000 gal.)
Tile field: each trench r fc-; feet / Total system length: /3 L- feet
Seepage pit(s): number of / size each: ft.by ft.
Size of stone to be used: # 2 / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: i Size of each: gallons
CA1 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 Qoeersbury, any permit or
avFrvval r --' -1 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 behr;lf of an applicant, aiuil be void.
I have rid the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queers ..-y Sanitary Sewage Disposal Ordinance. ,-� 1
Signature of responsible person: -, c1 l am. ` Date: r- ,2e: y /-
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name CouN r2YK&A-A)
Location £4-y A✓,)
Date f/Z-V iq Permit # qq�pc Z
SOIL T E: Sand-Loam-)ay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD:. Totil L,e'ngth 13?-
Length of each trenr�fi"jay /2. Er a
Depth of trenches /
Size of stone
SEEPAGE PITS: mber-
Size - ,ft. x ft.
Stone size ,`
PIPING: / Size Type
n
Bldg. to Tank 0
Tank to Dist. Box
Dist. Box to Field/'A N 3- 0
Openings Sealed? 407 No Partial
LOCATION/SEPARATION :
Foundation to Tank ` feet
Foundation to Absorption 75 feet
Separation of Pits _ feet
Conforms as per Plot Plan Ye No
LOCATION OF SYSI- 'ROPERT .
(circle one)
Front - Rear Left Sid Right Side
Middle Front - - *ear
COMMENTS:
SYSTEM USE APPROVED: 1111111 NO
Arrived:
Departed: i-V-710,0
Building Inspector
9q - cco ,
RFCFVED
SEP 2 0 1999
TOWN OF OUEENSBURY
BUILDING AND CODE
'Altrl Mr.C.C.ITrjilerli Shall
the
cre in fuH
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this document I also represent that I have
-• ly measured the 'stances s forth on the diagram."
IGNATURE DATE
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