99-467 CERTIFICATE
OF NCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date July 29 19 99
99467
This is to certify that work requested to be done as shown by Permit No.
has been completed.
• This structure may be used as a SEPTIC ALTERATION
location 52 BOATHOUSE RD.
Owner ARNSTEIN, WALTER H.
TAX MAP NO, 11 . -1-31 By Order of Town Board
TOWN OF QU ENS URY
Director of Building & Code Enforcement
. k.. .- ,. . . _e
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 99467
TAX MAP NO. 11 . -1-31 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to ARNSTEIN, WALTER H,.
OWNER of property located at 52 BOATHOUSE RD. Street,Road or Ave.
in the Town of Oueensbury,To Construct or place a SEPTIC ALTERA T'TUN
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
TRUSTEE 12 EAGLE POINT RD.
HAMPTON, VA 23669
2. CONTRACTOR or BUILDER'S Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
JAY SWEET
0
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( I Wood Frame ( 1 Masonry ( )Steel 1 1
7. PLANS and Specifications
SEPTIO'IoALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 July 28 191999
$ 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 Queens ry this 28 Day of July 19 1999
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept of Community Development Permit No. (C)
Building &Codes Office F °I D J
742 Bay Road Fee Paid $ _
Quensbury, NY 12804 JUL 2 8 1999
Location of property for instep " 2. __ft b 0 et 7' 0,4
Property Owner's Name: ()_,1 c'Y ) A )',/i e Tc r /3
Property Owner's Mailing Address:
Installer's Name: 6--) { :.-.-�:�,r �r rS:17:4t:';'1"- Phone # '7 f' =5 6 if
. Number of bedrooms (if residential): Total daily flow: • "
(residential - compute @ 150 gal./bdrm.)
Topography: X` flat, rolling, steep slope % of slope
Soil Nature: sand, x loam, clay, other I depth:
Ground water: at what depth? C feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: i not required, required [rate min. per inch
Domestic water supply: municipal, well, other /tea
If domestic water supply is a WFT T , water supply from any septic absorption is C feet.
PROPOSED SYSTEM
Septic tank:A."z ' gallon (minimum size: 1,000 al.)
Tile field: each trench VC, - feet I Total system length: `_2_0 feet
Seepage pit(s): number of / s=ze each: . ft.by ft.
Size of stone to be used: ir / depth or thickness / feet
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CAlarm system and associated electrical work to be inspected by a certified agency.
For yci.:protection, please note that pursuant to Section 136-29 of the Code of the Town of Queens bury, any permit or
kapro all waned which is based upon or is granted in reliance u on 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 and all requirements of the Town of
Queersbtsy Sanitary Sewage Disposal Ordinan . r-,
Signature of responsible person: �" � �:�-t' , � Date:
I
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date ins i e '. •ques • 'ved:
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive Po am/pm Depart am/pm
Inspector's Initi. s f-
NAME: \J. `4 /U /- PERMIT# di'
LOCATION: ,k DATE : l64
TYPE OF STRUCTURE:
RECHECK
N/A YES NO 'OMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place re � ��,A/'
The contractor is responsible for e- d� five—
providing protection from freezing fT 1Az
for 48 hours following the placement fir''
of the concrete.
Materials for this purpose on site__
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling ►-
Duct wor or piping i
unhe ed spaces R-
Proper Ve , Attic nt_
Framing
Jack Stu•s/Headers_
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour
Penetration Sealed
Fire Wall 2, 3,4 hour
Firestopping
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location Ffritj �� at.T.
��
Date — �
Z _ Permit #
SOIL TYPE: S.;nd-Loam-Clay-
Results of Pe\ olation Test-
(if applicabl .� Ra
te-Minute:
TYPE OF SYSTEM, nch
ABSORPTION FIEL► : Total ngth
Length of each tench
Depth of trenche
Size of stone
SEEPAGE PITS: Nu ' -
Size - ft. tw ft.
Stone size /A
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box \
Dist. Box to Feel d/Pit \
Openings Seal d? Yes . No Pa-
LOCATION/SEP '' TIONS:
Foundation o Tank feet
Foundation to Absorption \ feet
Separatio, of Pits \ feet
Conforms .s per Plot Plan ` Yes No
LOCATIi OF SYSTEM ON PROPERT
(circl one)
Front � Rear - Left Side - Right ide
Middl Front - Middle Rear
COMMENTS:
1--__A\1\00-T-- 031-1C_ (3\?,51-Eil
JB)) 6t-6EET. kT
SYSTEM USE APPROVED: YES NO
Arrived:
Depar
Tiding I p ctor
...
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date? .-9 Permit # 7
SOIL TYPE• Sal.e. oa :y-
Results of Percolat on T:st-
(if applicable) Ra e-Min to/Inch
TYPE OF SYSTEM: 1
ABSORPTION FIELD: Tot: Length _
Length of each t e (lad
Dep of trenc = . ` `
Size o e -A?,
SEEPAGE PITS: 'lumber-
Size - t. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank t�", p,j 5
Tank to Dist. Box uit
Dist. Box to Field/Pit 41t
Openings Sea ed? Yes No Partial
LOCATION/SEPARATION : fv,64,a_
Foundation to Tank feet
Foundation to Absorption ,-2`p feet Tre
Separation ofPits eet
Conforms as per Plot Plan 403111Ni.
LOCATION OF SYSTEM ON PROPERT
(circle o ___-- ..,
Front Rear eft Sid •_ght Side
Middle _ t i ear
COMMENTS:
SYSTEM USE APPROVED: cs] ES
Arrived:
Depar o
/t
B ldin • , . or
1111
? v // A ),-,-et/ci
I I J
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JUL 'g 8 1999
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"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 di nces set forth on the diagram."
• I 2
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(-- \S141ATURE DATE
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