91-729 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 28, 19 2.1
This is to certify that work requested to be done as shown by Permit No. 91-729
has been completed.
This structure may be occupied as a Septic Alteration k.
Location Tee Hill Road
Owner Daniel Lynch
By Order Town Board
TOWN OF QUEENSBURY
)s;\805it,,,i
Director of Bldg. & Code Enforcement
BUILDING PERMIT
• TOWN OF QUEENSBURY
No. 91-729
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Daniel Lynch
OWNER of property located at Tee Hill Road 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. OWNER'S Address is
Same
2. CONTRACTOR or BUILDER'S Name
Glenn Batease
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
( ►Wood Frame ( ) Masonry ( 1 Steel ( 1
7. PLANS and Specifications
Septic Alteration to include:
No•1000 Gal. Tank with 3 seepage pits each 6' x 8' using #3 stone
as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES October 24, 19 93
(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 24th Day f October 19 91
SIGNED BY for the Town of Queensbury
Building and Zoni Inspector
1
-/ / TOWN OF QUEENSBUh
` j TOWN OF QUEENSBURY RECEIVED
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # 6f//-`J: C�
OCT 2 3, 1991 Fee Paid ---
Date:Date: it) -lL> -el/
BLDG. & CODE DvT.ewed By
LOCATION OF PROPERTY FOR INSTALLATION: fee 4fp Ød1
co what('
Owner' s Name: J9JIJJ
Owner' s Mailing Address:
Installer' s Name: ( (Q,14Ljtja aa_ Phone #: 1l) 1 7
Number of bedrooms (if residential ): j TOWN OF QUEENSBUh
t=:ECEIVED
Total daily flow (residential-compute @ 150 gal . per bedroom):
Topography-Circle One: Flat Rolling Steep Slope % of Slope OCT 2 3 1991
Soil Nature-Circle One: CS2.1)id Loam Clay Other /Deptis r,O_ & CODE DEPT.
Ground Water-At What Depth? _,it P)
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required '6equired/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank 006 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of / Size each: (p ft. x g ft.
Size of Stone to be used: # / Depth or Thickness feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: > /OP-5 hI
.own of Queen Jur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEMINSPECTION
NAME E 41l c
LOCATION �,�Q, 441,/
DATE /D/ / 6/1 PERMIT NO. 9f✓ - 72
SOIL TYPE - Sand -Cato Clay -
Percolation Test Re. ed? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, t tal length
Length of each tren
Depth of trenches
Size of gravel_
SEEPAGE PITS{Nuinber o ) 3
Size- 6 ft. X R' f �, a
Gravel size 3
PIPING: azats Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit Gj
Openings sealed? YE NO Partial
f
LOCATION/SEFARATIONSf•
Foundation to tank ,f /U ft.
Foundation to absoyiption '• 020 ft.
Absorption to lot:line 7 ft.
Separation of pip
LOCATIO, ON PROOERTY(circle one)
Front 4 -
Y ft side �'; Right side -
COMMENT :
;r
SYSTEM USE APPROVE YE
Build ng Inspector
01/86 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED 6802qgy
NAME 1G,U cc) 'E1-1 G.ri G ha if)
LOCATION Cdr n0►� C.)e5-)- + Old +
DATE 91301 qc PERMIT # G 3 —729
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES/5
FOOTINGS/PIERS
MONOLITHIC POUR FORM ,r
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPO SIBLE ,
FOR PROVIDING PROTECTIO FROM
FREEZING FOR 48 HOURS FO,LOWING
THE PLACEMENT OF THE CONC'ETE.
MATERIALS FOR THIS PURPOS ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE j4v
0:017t°1a.
BACKFILL APPROVAL
ROUGH PLUMBING L." .
PLUMBING VENT/VENTS IN PLA' ✓
PLUMBING UNDER SLAB
FRAMING: `
JACK STUDS/HEADERS f
BRACING/BRIDGING 71 v52'
JOIST HANGERS
JACK POSTS/MAIN B M :/
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALL EXTERIOR R-
FLOORS R-
WALLS ' R-
CEILING R-
DUCT WORK OR PIING IN UNHEATED
SPACES
REMRKS: c( ¢L 'v',
Po‘kS berAvp,
t' G�5 Co
LIN k-LA `k.)
Feet) -'tz•v.} F3Q0.Liw3G
'F 2 A S v VP%_%Ei'2- lb *- Via►'
7\,-‘1 1-kc3Ee ‘w
ARRIVE tp= rp ok%
DEPART \‘W p6""
SPEC
oA To t v45k)LAW— C- �