Loading...
97-599 CERTIFICATE Oa-� COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date October 20 19 97 97599 This is to certify that work requested to be done as shown by Permit No. has been completed. SEPTIC ALTERATION (TANK ONLY) This structure may be used as a Location 134 LAKE PARKWAY -- . Owner ADAM:- ON, CHARLES -& TAX ti1,P N . 9 ; -1.-1�3 By Order of Town Board TOWN OF QUEENSBURY Director of Building &Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY VALUE $ 0 - No. 97599 TAX HAP NO. 9. —1-10 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to . ADAMSON. CHARLES & OWNER of property located at 1 '44 LAKE PARKWAY Street. Road or Ave. in the Town of Queensbury,To Construct or place a SEPTIC ALTERATI-ON (TANK ONLY) - 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 LILLIAN 134 LAKE PARKWAY = LAKE GEORGE, NY 12845 2. CONTRACTOR or BUILDERS Name QUEENSBURY SEWER ••• 3. CONTRACTOR or BUILDERS Address - JAY SWEET 4. ARCHITECT'S Name 5. ARCHITECTS Address 6. TYPE of Construction—(Please indicate by X) )Wood Frame ( )Masonry *( )Steel 7. PLANS and Specifications, SEPT ie' ALTERATION. AS PER PLOT_ PLAN SPECICEICATIONS 8. Proposed Use. SEPTIC, ALTERATION, (TANK ONLY) $ TFIISPERMIT EXPIRES October (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 SIGNED BY - Jtkfor the Town of Queensbury Building and Zon' Inspector Application for SEPTIC DISPOSAL PERMIT Town of Queensbury Permit No�, —J Dept. of Community Development Cl Building &Codes Office 742 Bay Road Fee Paid $ Queensbury, NY 12804 Location of property for installation://. e . QC- C( 4. '4141 Property Owner's Name: CIA a `- l f S ,404 , Property Owner's Mailing Address: / 3 9' k 446 p Installer's Name: 4110 to ec,d� 0 p—v" Phone # 7 Z cz t Number of bedrooms (if residential): 5 Total daily flow: (residential -compute @ 150 gal./bdrm.) Topography: bC flat, rolling, steep slope •% of slope Soil Nature: sand, loam, clay, _other /dep -PrECFIVED Ground water: at what depth?. feet / Bedrock or Impervious erial: p feet • Percolation test:. not required, required [rate min. pt rr h bf•0 ; Y; iilR`f tJ 2.19Vv A?'JD CODE Domestic water supply: municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. PROPOSED SYSTEM Septic tank.`es gallon (minimum size: 1,000 gal.) Tile field: each.trench ' feet / Total system length: feet Seepage pit(s): number of / size each: ft. by ft. Size of stone to be used: # / depth or thickness feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each.: gallons CAIann system and associated electrical work 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 approval granted which is based upon or is granted in reliance ugxm any material misrepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant;shall be'vokL I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanifpry Sewage Disposal • Signature of responsible person: c e Date: id ' r rV, i •�J Y �_l TOWN OF QUEENSBURY BUILDING A CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION () � Name C,G���i 0 AGct/Y1V_,).CA/1 Location / L j -%) Cj k(-='. �'O,A„L'CL- Date/ C) oi ��� �� � Permit #� J — �� „ SOIL TYPE: Sand-Loa -Clay- Results of Percolat on Te t- (if applicable) ,Rate Minu '•/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Tota Length Length of each trench Depth of trenches Size of stone L11//Q^, SEEPAGE PITS: Nu i'a"- IJ/ Size - ft , x / ft. Stone size PIPING: Size Type Bldg. to Tank 1 S Tank to Dist. Box -�-- Dist. Box to Field/Pit J? Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank lv 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: NO Arrived: /73J Departed: OA- Building Inspector _ . I have seen or observed,or,believe I saw evideNelkilt all objects such as houses, wells,trees,fentilkilkat • . . shown on this document. I also represonttbdifillin natty measurere dista ,t 4. set fedkakiiiiii.ge . 9. / SitiNATURE . -4.VW OM—V"INIIII 1' , /, / 7oci F c-2 d e ,1• \., .. . • <-7) 9C ---:--> —,.. .i TOWN OF QUEENSUY '' B U L. REVIEWED BY . - DATE A . .