98-694 �..
• •
Certificate of Compliance
Town of Queensbury
Warren County,New York
February 29, 2000
Date
98694
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
302 CLEVERDALE RD.
Location
Owner LIVINGSTON, DOUGLAS &
TAX MAP NO. 13 . -3-14
By Order Town Board
TO QUEENSB9J Y
e/-,x "
Director of Building Code Enforcement
- - ._
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY Na 98694
TAX MAP NO. 13. —3-14 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LIVINGSTON. DQIIGLAS st
OWNER of property located at 302 CLEVERDALE YD Street.Road or Ave.
in the Town of Oueensbury,To Construct or place a SEPTIC AT.TII.PATIC)N
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
SUSAN 5340 BALFOR DR.
VIRGINIA BEACH, FL 23464
2. CONTRACTOR or BUILDERS Name
ROULIER, CHARLES
3. CONTRACTOR or BUILDERS Address
CLEVERDALE, NY 0
4. ARCHITECT'S Name
6. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
1 1 Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
SEPVC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 October 29 2000
$ PERMIT FEE PAID—THIS PERMIT EXPIRES 19
Of 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.)
29 October 1998
Dated at the Town of Oueensbury this sy of 19
SIGNED BY '- ` K.)42 — for the Town of Oueensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury C&ing
Dept. of Community Development Permit No.
Building &Codes Office a
742 Bay Road Fee Paid $ r
Queensbury, NY 12804
l.
Location of property for instalii?on G l..e.-g lei. 4'
Property Owner's Name: ,De yy 4.5 .sys�a�+ ���,i.�,f s�,
6•Awl ma /Seam‹.
Property Owner's Mailing Address: •s"-3 j/o ,,o'.c.i .V,.,... 1 f. ,,.q „03 VC y
. ).c.
Installer's Name: ., • , :, Phone # e 4--e-3 e'y y
Number of bedrooms (if residential): .3 Total daily flow: �J a
(residential - compute @ 150 gal./bdrm.) '
Topography: flat, rolling, steep slope _..3 % of slope
Soil Nature: sand, )l loam, clay, /9'.xec ther I depth:
Ground water: at what depth?N'•-" eet / Bedrock or Impervious Material: at what depth?' feet
Percolation test: not required, Y required [rate 73.4, min. per inch
Domestic water supply: municipal, well, other -. .,, e,
If domestic water supply is a WELL, water supply from any septic absorption is — feet. .
PROPOSED SYSTEM
Septic tank. ..b gallon (minimum size: 1,000 gal.)
Tile field: each trench .sir feet / Total system length: —'— feet
Seepage pit(s): number of / size each: - ft.by ft.
Size of stone to be used: # / depth or tiziclmess feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
.-
jAlarm system and associated electrical Rork to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or
appivval granted which is based upon or is granted in reliance upon 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
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible personl Date: //y,0
c:)_P '•
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name v U
Location
Date l )--I S C((Permi t # C _(
4R
SOIL TYPE: 4Sand-Loam-Clay-
Results of ' -rcolation -
(if applicabl -) Rate nute/Inc
TYPE OF SYSTa
ABSORPTION FI I Total Length
Length of - .ch tr- . h
Depth o trenches
Size 4 stone
SEWAGE PITS: Number-
S��ze - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/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 :—
Front - Rear Left Side - Right Side
Middle • : - Middle Rear
COMMENTS:
Gf LA( Silcue
7
SYSTEM USE APPROVED: YES NO
Arrived: /' O
Departed:
WI
Buildi ng Inspector
TOWN OF QUEENSBURY /`/_74-
BUILDING & CODE ENFORCEMENT
742 Bay Road DA1)
Queensbury NY 12804i
(518) 761-8256
SEPTIC DISPOSA SYST M INSPECTION
Live) *.—
z
Name 2 //14,62. 1� �.
Location
Date P--( - Permit # 91'0c/
SOIL TYPE: San,-Loan lay-
Results of 'ercolation - •t-
(if applicab e) Rate- 'e/Inch
TYPE OF SYST -
ABSORPTION FIELi. To . ength Q2/O
Length of each tre
Depth of trenches /-2
Size of stone
SEEPAGE PITS: N ber-
Size - f . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank Q?" ' fb_
Tank to Dist. Box
Dist. Box to Field/P Sib
Openings Sealed? Ur No Partial
LOCATION/SEPARATION :
Foundation to Tank D feet
Foundation to Absorption 2 0 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: irk
Soka),/ retfistei fie
Auld . 0,/%1 d i
SYSTEM USE APPROVED: YES NO'
Arrived: A3o
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name iLft4{
Location L- a attee4
Date /2// Y Permit # 19 .6gY
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/In h
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Lengt
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size .�
PIPING: ize Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Y-s • Partial
LOCATION/SEPARATIONS
Foundation to Tank feet
Foundation to Abso stion feet
Separation of Pit- feet
Conforms as per P of Plan es No
LOCATION OF SYS M ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived: /i 3d
Departed:
Build Inspector
TOWN OF QUEENSBURY i/i)
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name //711,
Location CAku:A r�
Permit #
6 %0 f' 9‘E-0)Lf
Date �`
SOIL TYPE: Sand-Loam-Clay-
Results If Percolation Test-
(if appl cable) Rate-Mi - nch
TYPE OF 'YSTEM:
ABSORPTI1 FIELD: •tal Lengt
Length of -ach t'-nch
Depth of tre , -s
Size of stone
SEEPAGE PITS Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/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: (c).- jiy, 4,4)
SYSTEM USE APPROVED: YES 6i3
Arrived: `'2
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name - 14 )I I(10 -0 -
Location - .(, 'fir
Date it 1/ Permit #
3-Vi`i
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size ._
PIPING: ize ype
Bldg. to ank
Tank to Di Bo
Dist. Box to
Openings Seale ? Yes No Partial
LOCATION/SEP TITS:
Foundation t Tank feet
Foundation Absorption _ feet
Separation of Pits feet
Conforms as per Plot P1 an Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
"i9z 4.4
4,4
Ciro c*-3 Co/1/7
Cae- /e1J' % -
SYSTEM USE APPROVED: YES
Arrived: 9 27.,)
Departed:
@1-
Builthng Inspector ector
TOWN OF QUEENSBURY /0AW'
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name v t
Locatio
Date Ig- - g Permit #
449
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYST I :
ABSORPTION F LD: Total Length
Length of eac trench
Depth of trenc -s
Size of stone44111.
SEEPAGE PITS: : -
Size - ft. x
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption _ feet
Separation of Pits feet
Conforms as per Plot P1 an Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
p 4 \
( A/ 41-`1
SYSTEM USE APPROVED: YES 0
Arrived:
Departed: 7 l
7.1
Building Inspector
.41
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name I,-.Iv\, 6i.)1-()1��
Location (-302_, CLE)ED4LE PP
Date Permit # 9 -r$94
SOIL TYPE: Sand-Loam-Clay-
Results of Percolat•on T- t-
(if applicable) Ra 'e-Min to/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tot. Length
Length o each t : ' -
Depth of trenc e •
Size of stone
SEEPAGE PITS: umber-
Size - t. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to ield/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:
SYSTEM USE APPROVED . YES NO
Arrived: it!°:://)
Depart- , it
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id
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"------e-,. FEB 2 8 2000
NAME: DATE: IN OUT
- JOB NAME& LOCATION:
TRUCK JOB DESCRIPTION:
450 DOZER
850 DOZER
BACKHOE
TRACKHOE
PAYLOADER
FORD TRACTOR
YORK RAKE MATERIALS:
GRADER
CHIPPER
LABOR
TOTAL
JOB NAME& LOCATION:
TRUCK JOB DESCRIPTION:
450 DOZER
850 DOZER
BACKHOE
TRACKHOE
PAYLOADER
FORDTRACTOR
YORK RAKE
GRADER
MATERIALS:
CHIPPER
LABOR
TOTAL
` JOB NAME & LOCATION:
TRUCK JOB DESCRIPTION:
450 DOZER
850 DOZER
BACKHOE
TRACKHOE
PAYLOADER
FORD TRACTOR
YORK RAKE MATERIALS:,, ..
GRADER
CHIPPER a,
LABOR
TOTAL
CRANDALL EXCAVATING, INC.
TOTAL HRS.
OE , `
OULIER, INC. _ (518)65e-
. / f. RS _[ BOX 301,CLEVERDALE,N.Y.12820
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Based on ostr tilt .�exam yatiori, `� 0
cemphance wlth e r commtnts shall- `'� 4
V not he construed a.Indica ngi the F o�
v plans and sp'eclt,. Ions er�in full
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