1999-015 •
-a- • • •. .
*
• Certificate of • Compliance
•
Town of Queensbury
Warren County,New York
January 2 8 9 9
• Date
30 a 1--11219'
99015
This is to certify that work requested to be done as shown by Permit No.
has been comijleted.
SEPTIC SYSTEM FOR 3 BEDROOM HOME
This structure may be used.as a, •
no OLD eURGh—RD.
Location
• MC FEE, STANLEY & BARBARA
Owner
TAX MAP NO 1 1 9 . '7
By Order Town Board
TO UEESBL3 •
am," br•;z,
Director of Building& Code Enforcement
•
, . . - — •g...)06.1MMEM
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 99015
TAX MAP NO. 119 . -3-7 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to MC FEE, STANLEY & BARBARA
OWNER of property located at 58 OLD FORGE RD Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC SYSTEM FOR 3 BEDROOM HOME
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
58 OLD FORGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
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
SEPTIS. SYSTEM AS PER PLOT PLAN AND SPECIFICATIONS
8. Proposed Use
SEPTIC SYSTEM FOR 3 BEDROOM HOME
25 January 21 19 2001
$ 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.)
21 January 19. 1999
Dated at the Town of Queensbury this Day of,
SIGNED BY for the Town of Queensbury
Building and oning Inspector -
Application for SEPTIC DISPOSAL PERMIT
r
Town of Queensbury qq-O
Dept- of Community Development Permit No. /�
Building &Codes Office \,nn/�� : 0- 3 -7
742 Bay Road C
Fee Pa
p?
Que=nsbury, NY 12804
L
Locat?on of property for installation: 74--s r 0�li/�pr7 f J JAN 21 1999
Property Owner's Name: 54-6.,.-k, /`i �� �BV lQI VEENSBURY
6 AND COpE
Property Owner's Mailing Address: S a-6 (c1/`0f e- o)
Installer's Name:
I („7 -S��(�l C Phone # 7 9v:-75 -M (
Number of bedrooms (if residential): Total daily flow: KrZ
(residential -compute @ 150 gal./bdrm.)
Topography: /flat, ro iing, steep slope % of slope
• Soil Nature: (1 sand, Ioam, clay, other /depth:
Ground water: at what depth?Wirier / Bedrock or Impervious Material: at what depth? feet
Percolation test: / i/71-not required, reoui-r.ed [rate min. per inch]
Domestic water supply: X municipal, well, other
If domestic water supply is a WFT.1, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank/ D d gallon (minimum size: 1,000 g_l.)
Tile field: each trench feet / Total system Iength: feet
Seepage pit(s): number of / size each: . 0 ft. by 7ft.
Size of stone to be used: # 3 1 depth or thickness / feet .
HOLDING TANK SYSTEM: (if required)
Number of tanks: - Size of each: gallons
F
Alarm 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 Qoeensbury, any permit or
apcnvv a1 sr ar'M which is based upon or is granted in reliance any material misrepresentation or failure to make a
material fact or circumstance kmwn by or on behalf of an applicant, Fha11 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
Queer..s'c- Sanitary Sewage Disposal Ordinance.
Signature of responsible person: o
Date: �a) / -1/
TOWN OF QUEENSBURY
WILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name c_41A0 MC, Vs
Location 5E b1 V-A)
Date -z -99 Permit # —pI c'
SOIL TYPE: Sand-Lo:m-C ay-
Results of Per of ;tion est-
(if applicable •..te-Mi ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD • al Length
Length of each t ench
Depth of trenche .
Size of stone
SEEPAGE PITS: .N mber-
Size - f•. .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 et
Conforms as per Plot Plan
LOCATION OF SYSTEM ON PROPER .
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
-i3oIL 6 EPA-ic
SYSTEM USE APPROVED: YE N
Arrived:
Depart
�ld�ng . ns c r
1
x
V
T t:
. ...,:, ,,,,, _
V �h•y ((``���
�1 W U
•
5. .
r
• 1
/0c,
TOIIN •
OF QUEENSBURY .
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 57 //'C,Ee
Location r o -----r 1,
c,
Date / v O
l o[ f Permit # qq-0/,(
SOIL TY' . a «am-C-Tay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Leng h
Length of each trenc?
Depth of trenches
Size of st e
SEEPAGE PITS: ' .-re-r- Z
Size - ', ft x . ft.
Stone size -
PIPING: Size Type
Bldg. to Tank L ,
Tank to Dist. Box ��
Dist. Box t • �� -��o File 'it iti
Openings Sealed. WEE! No Partial
LOCATION/SEPARATIONS:
Foundation to Tank ; feet
Foundation to Absorption feet
.Separation of Pits _ Meet
Conforms as per Plot Plan No---
LOCATION OF SYSTEM ON PROPERTY:
(circle one
Front Rear ` Left Side - Right Side
Middle Front Middle Rear
COMMENTS:
SYSTEM USE APPROVED: ik]CLi-17---')
Arrived: rj � �
Depart-, :
/40
A641/1!:;(
Bui , ' g nspector
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'Zap
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Q. � Q
(6 it(t jil.f,r40- 4;)-
On
�;s•h
TOWN ®F QU�ENS�U RY o %.. 5c v ` ��
"I have seen or observed, or . ;
BUILDING & ii% �'T• all objects such as houses w
aw • <ha a ot,
REVIEWED BY ,� .•.. shown on t documa wells, frcr ,A
', document. I alc ic.,
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Personals �asered t � repress ;: I have
DATE is« ices set fort;, :he diagram
DATE
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