96-674 41MMINSIMAMMImmorim•-•
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
November 6 96
Date 19
96674
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION
This structure may be used as a
810 BAY RD.
Location
SEEMIUELLER, LUDWIG
Owner
TAX NAP NO. 60. -1-10 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
•
BUILDING PERMIT
TOWN OF QUEENSBURY 96674
VALUE S 0 No.
TAX MAP NO . 60 . -1-10 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
SEEGMUELLER, LUDWIG
OWNER of property located at 810 BAY RD . Street,Road or Ave.
SEPTIC ALTERATION
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
810 BAY ROAD
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
CONDON SEPTIC & DRAIN SERVICE
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
( )Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
SEPIQbIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 October 28 98
$ 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 Queensbury before the expiration date.)
28 October 96
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
uilding and Zoning Inspector
Application for
[SEPTIC DISPOSAL PERMIT STAMP RECEIVED
Location of property for installation:
L U��t f 6 'ff 6h9 t) IIF/� PERMIT NUMBER
Owner's Name: V4'
V
Address: Q'ld .(�14 /2� ' 7 '3,'1)-O/ 67
r
Installer's Name: W-")d'YU f Ter rft `t .1-D4A i Rl SF/ FEE PAID �cco
Phone #: /e 79j gS' C/ 2.--
Number of bedrooms (if residential): ‘")'
Total daily flow (residential - compute @ 150 gal. per bedroom): 3.5 a
Topography: EX Flat 1-1 Rolling E1 Steep Slope % of Slope
Soil Nature: FX Sand n Loam n Clay n Other /Depth:
�, pp
Ground Water: at what depth? /�/",41 feet
Bedrock or Impervious Material: at what depth? MP—.77A--
feet
Percolation Test: \ Not Required 1-1 Required/Rate min. pei, h
Domestic Water Supply: /3 Municipal Well r-i Other
If domestic water supply is a WELL: water supply from any septic absorption is to)D feet
PROPOSED SYSTEM:
Septic tank: 1'1/'� gal. (minimum size: 1.000 gal.)
66 f
Tile Field: each trench feet. / total system length feet.
Seepage Pit(s): number of / size each: ft. x ft.
Size of stone to he used: # 2— / depth or thickness l 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 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 o f 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�SSaanitar Sewage Disposal Ordinance.
oSignature of responsible person: �(.0 Date: /�^ —7‘
~ - TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C).
Location _
Date i -- -9' /Peit # 711
SOIL TYPE: Sand-Loam-Clay-
Results .,, Percolation Test-
(if applic.ble) Rate-Minute/Inch
TYPE OF SYS EM:
ABSORPTION ' ELD: Total Lth 1,06
Length of eac "en h I '
Depth of tren
Size of ston Miff
-
SEEPAGE PIT. : ¶ ber-
Size - f . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 49-4-t'-
Tank to Dist. Box
Dist. Box to Fieid/P — 'jam
Openings Sealed? a No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERT mow
(circle
Front - Rear - Left Side -Right Side
Middle Fr nt - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: NO
Arrived: /C• .CZ�
Departed: /0 ' 00
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name l
v
Location _
DateILSAta--- Permit # -62
SOIL TYPE: Sand-Loam-Clay
Results of Pe col . ion Test-
(if applicable Fate-Minute/Inch
TYPE OF SYSTE -
ABSORPTI. - L► : Total Length
Length of each t ench ---'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 ,���� ��4"
Dist. Box to Field/Pi
Openings Sealed? J No Pa`
LOCATION/SEPARATION :
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 FrontNiddleRar—)
COMMENTS:
SYSTEM USE APPROVED: ES(:::;-2:L
O
Arrived-
Depa r ed: �. {
:uild . Inspector
PLOT PLAN
SEPTIC SYSTEM
Notice: The following statement must be "stamped" on your plot
plan. This sheet of paper may be used for purposes of
drawing your plot plan. After drawing such plot plan,
please read the statement and sign it. If you choose to
use other paper for your plot plan, the office will stamp
those plans for your signature.
l8
D66
40
f91r4-!4'
so
�a
4., •
Nov 0 6 199s "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
personally measured the distances set forth on the diagram."
SIGNATURE DATE