99-356 Certificate of Compliance
Town of Queensbury
Warren County,New York
June 17 99
Date
99356
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
SUNNYSIDE RD.
Location
Owner MOHICAN GRANGE HALL
TAX MAP NO. 51 . -1-25
By Order Town Board
TOWN OfQUEENSBURY
)2:11;7:—
Director of Building Code Enforcement
BUILDING PERMIT
VALUE $ ® TOWN OF QUEENSBURY No. 99356
TAX MAP NO. 51 . -1-25 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to MOHICAN GRANGE HALL
OWNER of property located at SUNNYSIDE 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.
1. OWNERS Address is
172 SUNNYSIDE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
STEVENSON, WALT
3. CONTRACTOR or BUILDERS Address
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTICWALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
35 June 17 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(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.)
Dated at the Town of Queensbury this 17 Day of June 19 1999
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury ---tPrciVED Permit No. CIA9 "3� /►
Dept. of Community Development"' 1„„,
Building &Codes Office - 0°
142 Bay Road J U N ,
1 5 1999 Fee Paid S e
Queensbury, NY 12804 ))
Location of property for installation � L C O/t j" y
Property Owner's Name: //,f ti 4// G 4 'V C' A /l/6 € -
Property Owner's Mailing Address:
Installer's Name: Vif✓�Ca-./ I`�.c` Q /C >* 6 it/ Phone # 7 9.3 )-7 3
Number of bedrooms (if residential): Total daily flow:
(residential -compute @ 150 gal.fbdrm.)
Topography: t,�'oat, rolling, steep slope % of slope
- Soil Nature: sand, Ioam, clay, other I depth:
Ground water: at what depth? 7 feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: not required, required [rate min. per inch 1
Domestic water supply: municipal, well,weL, ocher
If domestic water supply is a WFT T, water supply from any septic absorption is f ' feet.
PROPOSED SYSTEM
Septic tanIc Io c'gallon (minimum size: 1,000 gal.)
Tile field: each trench 4 0 feet / Total system length: I t) feet
Seepage pit(s): number of / size each: . ft.by ft.
Size of stone to be used: # / depth or thickness feet
•
HOLDING TANK SYSTEM: (if required)
Number of tans: Size of each: gallons
CAlarra system and associated electrical work to be inspected by a certified agency.)
For you:protection, please rote that pursuant to Section 136-29 of the Code of the Town of Qoeersbury, any permit, or
approval grained which is based upon or is granted in reliance Lion 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 gad all req remerits of the Town of
Queensb+.-y Sanitary Sewage Disposal Ordinance.
Signature of responsible person: F r-�.--� �-'t-� 6
po pe � ��� C�`�� Date: /
re..—
TOWN OF QUEENSBURY ille
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name O.,,Agrvr....
Locationl'144
11 Date ' 17111 Permit: # 'rq•ii�p
SOIL T ,'E: Sand-Loam-Clay-
1
Results of PercolationXYTest-
(if applIcable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Totial Len ;7-0
Length of each trench
Depth of trenches i :,--3/
Size of stort i .Z
SEEPAGE PITS:: Numller-
Size - ft.,/x ft.
Stone size
PIPING: ` i Size Type
Bldg. to Tank O ,,
Tank to Dist. Bo 4" IOC
Dist. Box to Field 'it y* Slur
Openings Sealed? 400 No Partial
LOCATION/SEPARA-ION :
Foundation to Tank /6 feet
Foundation to Absorption 60 feet
Separation of Pints eet
Conforms as per lot Plan 400 No
LOCATION OF SYS ON PROPER '.
(circle one)
Front - Rear - Left Side - Righ'' Side
Middle Front - Middle Rear
COMMENTS:
\\...,.\A''------- . ,
SYSTEM USE APPROVED: YES NO G`~`
Arrived: //=3'
Departed:
pi
Building Inspector
i urnv Uf QUEENSBURY / r)97)
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
v ,\
SEPTIC DISPOSAL SYSTEM INSPECTION
Name sl , ;)rc __
Location
.r
Date I Permi t #
SOIL TYPE: Sand-Loam-Cla -
Results of Percolatio Test-
(if applicable) Rate ute/Inch
TYPE OF SYS M:
ABSORPTION ' ELD: Tb Length
Length of ea. tre
Depth of trenches
Size of stone
SEEPAGE PITS: Nu'-
Size - ft x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. BGtx
Dist. Box to Fie d/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:
Well Ax/- 4o1
c, Neij
7s/e)h
SYSTEM USE APPROVED: YES NO
Arrived: 110
Departed:
Building Inspector
TOWN ,_ QUEEi SBURy
BUILDING & D DEPT.
REVIEWED 3Y
DATE
11 ill i 1.I \yid 1_
11
51.-1-25 eL-)b� ,�''
8 VaG
Lk.--- 52.-1-49
51.-4-9 ,,k,N HO
-4-8 G.,/r ri?,i
51.-1-26 ,
iii
MO . 'CO
e Road
Q 54.-6-250
Ei 54.-6-1
54.-6-2
Produced by the Town of Queensbury, NY, Planning Department SCALE: One Inch Represents 100 Feet
06/17/1999
wil.is