98-743 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENS@URY
WARREN COUNTY, NEW YORK
Date December 1 19 98
•
98743
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
Location 217 TEE HILL RD.
Owner WILLIAMS, BRUCE & LINDA
TAX MAP NO. 48. -3-23. 1 By Order of Town Board
TOWN OF E BURY
Director of Building & Code Enforcement
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BUILDING PERMIT
VALUE $ TOWN OF QUEENSBURY No.
98743
TAX MAP NO. 48. -3-23.1 WARREN COUNTY,NEW YORK
PERMISSION is hereby granted to WIT,LTAMR. EBUr'E & LINDA
OWNER of property located at 217 TEE HILT, Pn Street,Road or Ave.
in the Town of Oueensbury,To Construct or place a 5FPTIr 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 Oueensbury Building and Zoning Ordinance.
1. OWNERS Address is
TEE HILL RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( 1 Wood Frame ( )Masonry ( )Steel ( 1
7. PLANS and Specifications
SEPIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
B. Proposed Use
SEPTIC ALTERATION
25 December 119 2000
$ 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 Oueensbury before the expiration date.)
1 December 1998
Dated at the Town of Oueensbu this Day of 19
SIGNED BY c for the Town of Oueensbury
Building and Zoning inspector
,
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No. 9g--7 4)3
Building &Codes Office �'
'0I 'n Paid �
742 Bay Road _ � Fee a J
Queensbury, NY 12804
Location of property for installation: Te (17, C( f'c
l 6 C.7
Property Owner's Name: 6/` C L. C„,... L(,�ti S
Property Owner's Mailing Address: /C C /9;/( /6
Installer's Name: i I 1 1, ‘,1;:'Q/ / (- Phone # -7 9/ ter` 2
Number of bedrooms (if residential): Total daily flow:
(residential -compute @ 150 gal./bdrm.)
Topography: n t, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what d-epthWA feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: /��/ 'not required, r ' ed [rate min. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is/0 C) feet.
PROPOSED SYSTEM
Septic tank:/e00 gallon (minimum size: 1,000 gal.)
Tile field: each trench Sd feet / Total system length:01 Q 0 feet
Seepage pit(s): number of / size each: . ft. by ft.
Size of stone to be used: # 02., / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: . Size of each: gallons
CA15rm agy.system and associated electrical work to be inspected by a certified agency.1
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 misrepreserta6on 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 applic 'on and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
ifi:Sig ature of responsible person: Date: //1i '--.9,--
Ink
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT ,`''0
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ) kf_? (JC)Istr:LS
Locatio417 ! Qt. LL
Date i` .-` 1 -Cg Permit # 9 g 743
SOIL TYPE: aii.-1aam-C1 ay- '
Results of Percolation T t- `\
(if applicable) Rate-M' ute/Inch
TYPE OF SYSTEM: /
ABSORPTION FIELD: T 'tal Lengthf 7�rx` -
Length of each tr ch �D`
Depth of trenche ..`z'
Size of stone /
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to ank Fg,k5t-
Tank to D` t. Box '- 16 C
Dist. Box to Field/Pi vt
Openings Sealed? Y o Partial
LOCATION/SEPARATI
Foundation to Tank IE-1l61 et
Foundation to Absorption 21)-+'feet
Separation of Pits eet
Conforms as per Plot Plan e
LOCATION OF SYSTEM ON PROPER :
(circle one)
Front - Rear - Left_S-i-der= 1 Side
Middle Front - 'ddl e R
COMMENTS: —`
SYSTEM USE APPROVED: YE 0
Arrived: ,,`'-0
Departed: .�a;'L1,gor/ c
: if ring In . or
i
"I have seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences,etc.,
shown . 1 is document I also represent that I have
dimeasured th istan set forth o tthe diagram."
SIGNATURE DATE
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REVIEWED BY ..or .;/AA .//i
DATE IA LZ
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