92-516 Cu R } `I.9.- ICATE OF COMPLIANCE
TOWN OF QUEENSBURY
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WARREN COUNTY, NEW YORK
Date /o%/ 19 92_
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This is to certify that work requested to be done as shown by Permit No. 92-516
has been completed.
This structure may be used as a Septic Alteration
Location Seelye Rd, Cleverdale
Owner Mark & Linda McCollister
By Order of Town Board
TOWN OF QUEENSBURY •
Director of Building & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 92-516 71
WARREN COUNTY, NEW YORK
IV
PERMISSION is hereby granted to Mark & Linda McCol l i cter
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OWNER of property located at Cleverdale Street, Road or Ave.
0
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. 'S
1. OWNER'S Address is
Seelye Rd
Cleverdale go
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2. CONTRACTOR or BUILDER'S Name 0.
Joe Roulier a
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address fD
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6. TYPE of Construction—(Please indicate by X) rh
( )Wood Frame ( 1 Masonry ( I Steel ( )
7. PLANS and Specifications
No. Septic Alteration to include: 1000 Gal. Tank as per plot plan
specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 26,19 94
(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 26th Da of ' August 19 97
SIGNED BY / - for the Town of Queensbury
Building and Zoning Inspector
` � SLR W O,F 'QU h5- U ° 'OW
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APPLICATION I - 1J S� A 'O g Permit # o?
REVIEWE Y 2 Ai Fee Paid
DATE 01 GU TOWN OF QUEENSE'U; .
Date: /1//)._ 'L ,14. _ Reviewed By RECEIVE'
LOCATION OF PROPERTY FOR INSTALLATION: ���✓a 6�.1 ZZAUEsti.Ki492V
Owner' s Name: 4..(--,), { i2c� i' /_ 'Z<,S
�/ ULu�. /:ODE DEM
Owner' s Mailing Address: �,,,,,,-,( a(. i- s-„� � ,z" ,
Installer's Name: o ,dam Phone #: ‘s 3,'YV
Number of bedrooms (if residential ): 3
Total daily flow (residential-compute @ 150 gal . per bedroom) : �-) a
Topography-Circle One: Fla tolling Steep Slope �.% of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet \/
Bedrock or Impervious Material-At What Depth? Feet c4
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other 46v-ec -7:2--
If domestic water supply is a well - ,
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank �, s— gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness feet /
-, ,-.7)&-;:": ,...„. --s--7 ,-/<- ---2—,F: ,----;:r. - ,.
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,_,,,. �.._,.. _ /�'� *#**********'k r„• la,,..v cc I
S i , ,,, G.mac ,
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks • Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
I have read the regulation on the reverse side of this sheet and agree to abide
by these, and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSO DATE: #:42---
,
•
Septic System Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1) the proposed location of the system
.2) . "location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution boxes, tile fields
and/or drywells
B. No system shall be covered before inspection and approval by the Building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot -plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks: •
...awn of beueeni4ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
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A, Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
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NAME 4,-)1/(d) /2t c .„A-eg../Aj �
LOCATION Ally4(
DATE 01 /9 PERMIT NO. -J/k
SOIL TYPE - Sand Loam 410
Percolation Test Required? YES - •N
Percolation rate - Min/Inch.
TYPE of SYSTEM:
Absorption field, total le-gth / /t//v
Length of each tr-nch• /
Depth of trenches " AW '` /"
Size of gravel'_ i / _
SEEPAGE PITS{Nuinber of) Air ,
Size- ft. X 1 ft /
Gravel size -12rf'
PIPING: S - T pe
Bldg. to tank fgl
Tank to dist. box y
�/- : 0
Dist. box to field/p/i.i %'
Openings sealed? /YES NO Partial
LOCATION/SEPARATIQNS: a
Foundation to tarok /Oft.
Foundation to abporption 4 L I-ft.
Absorption to lot line ' ft.
Separation of pits v_y, ft.
LOCATION OF SYSTEM ON PROP RTY(circle one)
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Front - Rear - side - Right side -
COMMENTS: `':,,
Ly4e-' \,,
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SYSTEM USE APPROVED (YES 0
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Bui3ding In p ct
01/86 and vl
Jown o/ Queenurty 6;)„,
BUILDING and ZONING DEPARTMENT
• Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME It c( .6-tl4 kt.)
LOCATION ae,--/i&C-dilitJ
DATE * /�Z PERMIT NO. PW'�/6 .
SOIL TYPE - Sand - Loaml Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: I
Absorption field's, total .length
Length of each trench'
Depth of trenches , 1
Size of gravel 1 E' v. ; '
SEEPAGE PITS*Number of),' *
Size- ft. X _A ft
Gravel size , I
PIPING: y�Size Type
Bldg. to tank I
Tank to.dist. box /
Dist. box to field/pft
Openings sealed? Y S • NO Partial
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LOCATION/SEPARATION :
Foundation to tank ft.
Foundation to abso tio, ft.
Absorption to lot ine ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROP RTY(circle one)
Front - Rear - Lef side - ight side -
COMMENTS:
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44/ •
V .
SYSTEM USE APPROVED YE
ldinT Inspector
01/86 and vl
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