95-422 -_— .-
CER,TIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
August 21 95
This is to certify that work requested to be done as shown by Permit No. 9 422
has been completed.
This structure may be used as a is i-'r1 x'k:'1'u1=1
Location 11 ,24 WO' kr, ,
Owner `:ltiriar1,13i.t1 '` tl )l i1:1
By Order of Town Board
Z „> ti.'- l• TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY 95422
TAX HAP NO. 60. -7-5. 1 No.
WARREN COUNTY, NEW YORK
CANTERBURY WOODS
PERMISSION is hereby granted to
1124 BAY RD.
OWNER of property located at Street,Road or Ave.
SEPTIC SYSTEM
in the Town of Queensbury,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.
1. OWNER'S Address is
1124 BAY ROAD
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTICo.SYSTEM AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC SYSTEM
$ 26 PERMIT FEE PAID —THIS PERMIT EXPIRES July 27 97 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 Queensbury before the expiration date.)
2 August 19 95
Dated at the Town of Queensbury this Day of
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
l
--- '- -3
' Application for SEPTIC DISPOSAL P1�;IRM11' O
STAMP Rl:('I?IVIA) Z
Location of properly for installation:
r /,nl T7/3 i/L y Ga;i #± O
10
Owner's Name; _ /`-•'62vX"C' wNG, /11- PERMIT NUMBER
Owner's Mailing Addiess: _
4 ,�� 9 5 490
eev6... eUs134/l /
tTi
MI'. �5
I'. '.'AII)
Installer's Name: _ Phone #:
tDO
1C1�..
Number of bedrooms (if residential): / 2 c /vi
Total daily now (residential - compute (li) 150 gal. per bedroom): �a GG p•�
Topography: LA Flat I___ Itullinl: I- I Steep Slope of Slop
Soil Nature: I i Sand I___J Io:un I i ,'lay I_I Oilier _ /DREG ED
Ground Water: at what depth? _--,f24/ 26a •• feet JUL2 C 1995
U C' t J
Bedrock or Impervious Material: at what depth'! Ni-/4-7,feet TOWN OF C JEENS IJRY s
BUILDING AND CODE
Percolation Test: I i Not Required I I Required/Rate i/ min. per met
Domestic Water Supply: LA Mctnicipal i I Well Li Other
If domestic wale, supply is a WF.I.I.: water supply hunt any septic ahsotptio„ is feet
PROPOSED SYS'TFM:
Septic tank: 3r-S gal. (minimum size: 1,000 gal.)
Tile Field: each trench &c-') feet. / total system length / ��D_feet.
Seepage I'it(s): number of — / size each: ft. x _ ft.
Size ul'stone It, he used: II / depth or thickness feet.
I101.DiN(1 'TANK SYSI FM: (if,equired) i
Number of tanks: Size of each: gal.
I.1� 7 A/anti system and associated electrical work to be inspected l,r a certified agency. 1
For your protection, pleci.se note that pursuant to ,Section 136-29 ()fare Code of the 7'onvt of
Queensbnry, any permit or a ppro, tl 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 o f an. applicant, .shall be void.
1 have read the regulations with respect to this a )plica(ion and agree to abide by these and all
requirements o f the Town o f Quee itsbtiry Saiti e y S aiU•.sp/l Ordinance. /0
i;i /t UIr1/' s>;:- i 15
Signature of re.sponsib'e person: - j Unlc.: 17 G"L�
c--\CS PN\
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location L
Date qj- 1--Ck Permit # 5
SOIL TYPE: Sand- oam-Clay-
Results of Percol , tion Test-
(if applicable) R.te-Minute/I h
TYPE OF SYSTEM:
ABSORPTION FIELD: •tal Len. h
Length of each tren•h
Depth of trenches
Size of stone
SEEPAGE PITS: Number
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Fieli/Pit
Openings Sealed Yes No Partial
LOCATION/SEPA' •TIONS:
Foundation Tank feet
Foundatio to Absorption feet
Separation o(= Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPER . :
(circle one)
Front - Rear - Left Side - Ri. t Side
Middle Front - Middle Rear
COMMENTS:
1/0/77//9 ,f1X4 44/f a-
err- arAi 3122,ec-
,,
SYSTEM USE APPROVED: YES `
Arrived: g1,61
Departed: 7.
Building Inspector
TOiNV OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name /2V,174 .e- 61 S l
Location
Date )41.ermit # S
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/I ch
TYPE OF SYST l.:
ABSORPTION FI D: Total Length
Length of each , rench
Depth of trench-
Size of stone
SEEPAGE PITS: Nu ber-
Size - ft. x ft.
Stone size
PIPING: S ze Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation off= Pits feet
Conforms as per Plot Pla Yes No
LOCATION OF SYSTEM ON PRIP 'TY:
(circle one)
Front - Rear - Left Sid - R ght Side
Middle Front - Middle R: ar
COMMENTS:
T/A47 F/74;� ( �
7---;-(1/4/ 3 41 ( j/r.
SYSTEM USE APPROVED: NO
Arrived: (? A
Departed: fS
Building Inspector
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 357 Elwyn Terrace — Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
45270 ^ r
Panel Board No. r, Cert.
t.� p _ Cut-in Card No.~.�. . •-M
pa
Owner effort �`ac�R`�
Occupant f�
Location sly) ! J 6- y
Installation Consisting of... . rGt fit frf 4t,( S �
Installed By4` Clf 5K Lic. #
The conditions following governed the issuance of this certificate,and any certificate previously
issued is cancelled:—
This certificate only covers the electrical equipment and installation conditions as of date. Upon
the introduction of additional equipment or alterations, application shall be promptly made for
inspection.
Inspectors of this Company shall have the privilege of making inspect" s at any time, and if its
rules are yr lated,the Com any shall have the right to revoke th' erti
Date INSPECTOR ,
Member N.F.P.A.,I.A.E.1.
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ir , fr deiacg
Location (s, xy7
Date f' Permit # 9�- 'I
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
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 feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
A.,(4
/1 Ede, .3 v‘ /4 J-1-4 .e Ycrlc°
SYSTEM USE APPROVED: YES
Arrived: l(,�
Departed: 47 a)
:?1-
Building nspector
Vt-lx`rI34sctiA:6Y-\
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
NameMa4-eAA. ,.., , i)...)60�
Location (li (),-)( -32,,
Date /9 -1 c Permit #01 5' Ll
SOIL TYPE: Sand-Loam-Clay-
Resul s of Percolation Te 7t-
(if ap•licable) Rate-Min to/Inch
TYPE OF YSTEM:
ABSORPTII FIELD: Tota Length
Length of -ach trench
Depth of t -nches
Size of sto e
SEEPAGE PITS Numrier-
Size ft. x ft.
Stone size
PIPING: IF Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Fie' d/Pit
Openings S-.led? Yes No Partial
LOCATION/ PARATIe S:
Foundati. to Tank feet
Foundat'.n to Absora ti on feet
Separa ''on of Pits feet
Confo .s as per Plot 1 an Yes No
LOCAT ON OF SYSTEM ON 'ROPERTY:
(cirile one)
Fron - Rear - Left Sid. - Right Side
Middle Front - Middle Rear
COMMENTS:
D te.,P f
y ell 1 / 7
SYSTEM USE APPROVED: YES NO
Arrived: /;;jz
Departed: 42,et
/ /-7
Building Inspector
7(. 116)-677)
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 124
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name N;vA , L kk.)6d() S
Location 610' OG,\A
Date q ft-C1 Permit # 5-4Q;L
SOIL TYPE: Sand-Loam-Clay- £
Results of Percola ion Test-
(if applicable) Ra ►--Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Ti al Length
Length of each trenc'/
Depth of trenches
Size of stone ,fir
SEEPAGE PITS: Numbkr-
Size ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Bohr
Dist. Box to Fierld/Pit
Openings Sealed/ Yes No Partial
LOCATION/SEPARA IONS: \,
Foundation to T nk feet
Foundation to sorption feet
Separation of its feet
Conforms as pe Plot P1 an ; Yes No
LOCATION OF S TEM ON PROPER:
(circle one)
Front - Rear Left Side - Right Side
Middle Front Middle Rear
COMMENTS:
Ar44-10(11
SYSTEM USE APPROVED: YES
Arrived:
Departed: !i • 3
Building Inspector
Y
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C ,v9 /Q /6/
Location , 41/ A .
Date 1//i/fr Permit # q e—/22
SOIL TYPE: 4 .-Lo m-Clay-
�/
Results of Pe colation Tes
(if applicabl Rate-Minn a/Inch
TYPE OF SYSTEM #
ABSORPTION FIEL' : Total Length, I2 ''
Length of each trench (A0
Depth of trenche '
Size of stone a ;/—
SEEPAGE PITS: Nu -
Size ft. T ft.
Stone size /'
PIPING: / Size Type
Bldg. to Tank
Tank to Dist. Bo* -`' 'SzDe 24
Dist. Box to Fi e,�d/Pith° 56k 3�
Openings Sealed Yes No Partial
LOCATION/SEPA IONS:
Foundation to ank feet
Foundation to bsorption /5''O feet
Separation oj- its feet
Conforms as p r Plot P1 an C No
LOCATION OF SYSTEM ON PRO'ERT .
(circle ....:'
Front - Re.. Left Side Right Side
Middle Front/ - Middle Rear
COMMENTS:
,P R 014 L 7 -- 1
wCe5 iu o`T `?Er \it -,r/(1-ilAe
SYSTEM USE APPROVED: YES ND
Arri ed: / ' 30
Depar ed: /j .
Ol-L CL...u6f O4)&
Building Inspector
YGY"&
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Namec:ip\AAL) N)1,),( 1.)e)( 1)._S
Location cet..,1,-,eq--\.3
Date I D ` 9S Permit # `14 a,
SOIL TYPE: S:n•-Loan Clay-
Results of 'ercolation Test-
(if applicaile) Rate-Minute/Inch
TYPE OF SYS 0 :
ABSORPTION F LD: Total Length
Length of each trench
Depth of trenc -s
Size of stone
SEEPAGE PITS: N ber-
Size ft x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box 560
Dist. Box to Field/
Openings Sealed? ( ` No Partial
LOCATION/SEPARATIs
Foundation to Ta 40 feet
Foundation to Ab .orption feet
Separation o+ Pi s feet
Conforms as per Plot Plan No
LOCATION OF SY EM ON PROPE.
(circle
Front e Left Side - Rig ,t Side
Middle r ont - Middle Rear
COMMENTS:
\: V\ /us ' °°
PO4 C CAAt4.1-70e, vit,5Tki t‘'
SYSTEM USE APP OVED: YES N )
Arrived: /
Departed: / % 0
L CLL,657--01,/
Building Inspector