99-093 •
Certificateof • Compliance
• . .
Town of Queensbury
Warren County,New York
April 29 99
Date.
99j93
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
63 MASON RD,
Location
Owner MA TTHEW S, JEAN
TAX MAP NO. 13 . -1-1 4
By Order Town Board
TOW- OF QUEEN $U Y V
ari7;,tf
Director. of Building& Code Enforcement
' BUILDING PERMIT
TOWN OF QUEENSBURY 99093
VALUE. . $ 0 No.
TAX MAP NO. 13. -1-14 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to MATTHEWS, JEAN
OWNER of property located at 63 MASON RD. Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC 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 Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
1428 HAINESPORT. RD.
MT. LAUREL, .NJ 08054
2 CONTRACTOR or BUILDERS Name.
CRANDALL, CHRIS.
3. CONTRACTOR or BUILDERS Address
R.D. :#1, . BOX -1376
LAKE. GEORGE, NEW- YORK 12845
4. ARCHITECT'S Name . .
5..ARCHITECT'S Address. .
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTINP•ALTERATION -AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 _. . March 31 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES . 19
(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.)
31. March 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY "Aille for the Town of Queensbury
Building and Zoning Inspector
" Application-for SEPTIC DISPOSAL PERMIT
G''Town of Queensbury
Dept. of Community De ;: Permit No.
Building &Codes Office - 9 9 0 9 3 13 . -1-14 : 0
742 Bay Road MATTHEWS, JEAN Fee Paid $
Queensbury, NY 12804 63 MASON RD.
SEPTIC ALTERATION J
Location of property for installation: m N /eoA- C ° ,-
ED
Property.Owner's Name: 3J9-,y m I T���i: J�C' MAR 2 6 1999
Property.Owner's Mailing Address: `A1 �c)iv .4m J C`...1; / 1 /�-L-Tc OF t1EENSBURy
BUIWING AND CODB
Installer's Name: e_.14,%4A11_2 F-AGi9 477N6- '/LPhone # !7 / � 'Oq3/
'—,t/ /"
Number of bedrooms(if residential):: Total daily flow: 4/56)
(residential -compute @ 150 gal./bdrm.)
Topography: -1' flat, : rolling, steep slope % of slope
Soil Nature: . sand; loam, clay, other /depth:
MO46 ;Prig--'N gi
Ground .water: at what depth? , feet / Bedrock or Impervious Material: at what depth? _ feet •
Percolation test: not required, X required [rate. (7 min, per inch]
Domestic water supply: , municipal, well, .other /„ /4
If domestic water supply is a WELL, water supply from any septic absorption is 7 :Y feet. .
PROPOSED SYSTEM
Septic tank/,12 gallon (minimum size: 1,000 gal.)
Tile field: each trench /IL) feet / Total system length: ;��, feet.
r Seepage pit(s):. number of .- / size each: ft. by ft.
•
Size of stone to be`used: ,1 % depth or thickness / feet
•
HOLDING TANK SYSTEM: (if.required)
Number of tanks: - Size of each: gallons
CA1ann-system and associated electrical work to be inspected by a certified agency. )
For your protection, Please rote that pursuant to Section 136-29 of the Code of the Town of Qaeenslbury, any permit or
approval 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 Sanit%ry Sewage Disposal Ordnance..
Signature of responsible person: �, / Date: /I 2
-I' TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name /1,v11�/y
Location 63 /'Ze,
Date 6/Z46 Permit # 7%—(,/ 3
SOIL TYPE: Sand Loap -Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length LA)
Length of each trench yc
Depth of trenches ,2
Size of stone v
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 5/b Sine
Tank to Dist. Box 2n'p• -
Dist. Box to Field/Pi , yt? J Z
Openings Sealed? es No Partial
LOCATION/SEPARATIONS:
Foundation to Tank %6 feet
Foundation to Absorption qS feet
Separation of Pits
Conforms as per Plot Plan Ye No
LOCATION OF SYSTEM ON PROPERTY:
(circle o
Front - Re�- Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
,r`,, , / G
„.,
SYSTEM USE APPROVED: YES NO
Arrived: /Obyt'
Departed:
Building Inspector
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545 �A` }
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
/
Panel Board No Cert.N2 6 6 1 1 1 Cut-in Card No
Owner .�,�(y�7 C I`-� " 2 Za.5
Location /)' U ' �I a" "' 1
Installation Consisting of 5 �� PiL ot-fs r4.065
Installed By 67' -22 Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making 'iaiiections at any time, and if its
rules are violated,the
Company.shall have the right to rev e thi
`�4 24
Date ` ? INSPECTOR....,t