96-320 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
June 18 9.6
Date 19
.96320
This is to certify that work requested to be done as shown by Permit No.
has been completed. SEPTIC ALTERtTTIOI1
This structure,ma used a a
f2 HILL ND, - __._
Location
tutt.c`rToN , bTE?HEN & LEI
Owner
TAX HAP NO. 48. -3- 50. 2 By Order of Town Board
TOWN OF QUEEN BURY
—— Director of Building & Code Enforcement __
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 9G320
TAX MAP NO. 48. —3-50. 2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BRITTON, STEP-MEN & LORI
OWNER of property located at 92 TEE HILL RD. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC 1a T I TIBN
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
92 TEE HILL RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDER'S Address
JAY SWEET MOBILE PHONE#744-0028
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
E(PTIC
( )Wood Frame ( 1 Masonry ( )Steel
S
7. PLANS and Specifications
SEPTt ALTERATION AS PER APPLICATION
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES Jnne 18 ,19 98
(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 18 Day of June 19 96
'
SIGNED BY 1s4‘11. for the Town of Queensbury
11 Building and Zoning Inspector
' F -Application for SEPTIC DISPOSAL PERMIT
S1'AMl' RECEIVED
^ d
Location of property tor installation: 7- H/// R�. )
Owner's Name _ e V �. lI 1 / ) 0 K! I'lil I' UM11SLR
Owner's Mailing Address: _ — 17l f/ 1 r330
(71
e tfSB`� �- o2500
� 'p PAID
Installer's Name:cl(fUi tx_r'y c?�ry Phone #: 1 9 � � 1i
r
Number of bedrooms (if residential): �MM
�--6 'C
Total daily Ilow (residential - con pute (fit IS(1 gal. per bedroom): JUN1 4 1996
Topography: t''V Flat ( ( Rolling (--] Steep Slope % of Slope _
Soil Nature: XI Sand I I Loam j (lay I Other /Depth:
Ground Water: at what depth"? — feet
Bedrock or Impervious Material: at what depth? feet
Percolation Test: (/ J Not Required ('( Requited/Rate _—min. pet inch
Domestic Water Supply: (__ ] Municipal 17-1 Well ( ( Other
O
If domestic water supply is a WELL: water supply from any septic absorption is � feel
PROPOSED SYSTEM:
M:
Septic tank: �ad - gal, (minimum size: I.Ol11)gal.)
the field: each trench _, 'Merl. / total system length t & feet.
Seepage l'it(s): number of / size each: ft. x ft.
Size of stone to he used: # / depth or thickness A" feet.
HOLDING TANK SYSTEM:M: (if required)
Number of tanks: • Size of each: gal.
IAlarm system and associated electrical work to be inspected by a certified agency.
For your prot'eertion, please note that pursuant to Section 136-29 of the ('rle of the 'Town of
Qneenshury, any permit or a p promo!granted which is based upon or is granted in reliance a pan
any material misrepresentation or.failure to make a material fact or circumstance known be or on
.behalf of an applicant, slur!!be void.
1 have read the regulations with respect to 1/us application and agree to abide by these and all
requirements o f the Town o f Queen. rt .Sanitary Sewag isposal rdinance.
Signature of:espon.cib'e person: Dale:
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,i1TE kI
Location V-V)
Date (0\191 Permit #%---37 ;
SOIL TYPE: Sand-Loam-Clay-
Results of Pe colation Test-
(if applicable Rate-Minute/Inch
TYPE OF SYSTEM
ABSORPTION FIEL►: Total ength j 1
Length of each trench 3 h? 1,Q1-IC!
Depth of trenche. 1
Size of stone at
SEEPAGE PITS: NuTr-
Size - f f ft.
Stone size . r-
PIPING: Size Type
Bldg. to Ta, ' lhT�
Tank to D' t. Box
Dist. to Field/P .t u t
1?1‘brtg_v-
Ope ' gs Sealed? Ye / o Partial
LikATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption 7O feet
Separation of Pits -- feet
Conforms as per Plot Plans
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
CO Edle Fr�'- Middle Rear
NTS:
•
SYSTEM USE APPROVED: ,YES NO
Arrived: 1
Depa
3/1
uilding ctor
/J 1--. :.
(I\
0 41
0\2 ql
Oil C.
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. "I have seen or observed.or believe 1 MI eviden ce
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,50(,,,„0,( 1 sahlloowbnjeocntsthissuch as house". wells,byes hues, etc v
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e c> ( I slip Want that I h
(1 195
ily messurod .
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