1999-194 CERTIFICATE ' OF COMPLIANCE
-TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 13 19 99
99194
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
13 MAPLEWOOD DR.
Location
MYLIE, PETER & NORA —
Owner.
•
TAX MAP NO. 68 . -4-3 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
•
BUILDING PERMIT
VALUE . $ .0 TOWN OF QUEENSBURY No. 99194
TAX MAP NO. 68 .—4-3 WARREN COUNTY, NEW YORK • •
PERMISSION'is hereby granted to' MYLIE, PETER & NORA
OWNER of property located at 13 MAPLEWOOD DR. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a • SEPTIC -ALTF..WATTn
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 .
13 MAPLEWOOD DR. •
• QUEENSBURY,. NY . 12804
2. CONTRACTOR or BUILDERS Name
. .MC. -GUIRE, • RICK..
3. CONTRACTOR or BUILDERS Address •
4. ARCHITECT'S Name •
•
5. ARCHITECTS Address •
6: TYPE of Construction—(Please indicate by X)
.. SEPTIC:,.:
( )Wood Frame ( I Masonry ( )Steel ( )
•
7.,PLANS and Specifications ,
SEPTIC ALTERATION. AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use .
SEPTIC ALTERATION •
25.$ PERMIT FEE PAID —THIS PERMIT EXPIRES April 29 1g 2001
•
(If a longer period is required an application for an extension must be made to the Building'and Zoning inspector of the
town of Oueensbury before the expiration date.) "
29 . • Apri.1 . 1999
Dated at the Town of Queensbury this Day of 19
r � '
SIGNED BY ` `� for the Town of Queensbury
Building and Zoning Inspector •
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury f
9,11
Dept of Communiry Development - Permit No. L
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
r "Fr\OC.0
Location of roe for installation: / 3 pt 9yp(-e �� (� ct.
property rty Uaca�S �n-., ,
Property Owner's Name: /°GT $y L r t ApR 2 9 1999
O AND
Property Owner's Mailing Address: 13 /7?,A Q 'o d fQ � JVVt�O�QUEE CQD�Y
•
Installer's Name: 7 C_ 7 7 0 o) Phone # 12 —S c%
•
. Number of bedrooms (if residential): y
Total daily flow: �ID.
(residential - compute @ 150 gal./bdrm.)
Topoaphy: 'n flat, rolling, steep slope % of slope
Soil Nature: l sand, loam, clay, other/depth:
• Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not reeuired, required [rate min. per inch j
Domestic water supply: municipal, well, other
If domestic water supply is a WFT.T , water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank gallon (minimum size: I,000 al.)
Tile field: each trench feet / Toil system length: feet ..
•
Seepage pit(s): number of / size each: . ' ) ft ,.by r ft. � �
Size of stone to be used: # I depth or thickness 2 feet • sizr 1
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(Alarm system and associated electrical work to be ..spected 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
a yiuval grazed which is based upon or is granted in reliance upon.ary material misrepresentation or failure to make a
material fact or circumstance known by or on behalf of sta applicant, cb 11 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
Queens vy Sanitary Sewage Disposal Ordinance. �p
Siotz are of responsible person: c— >/ V "t" \r Date:
TOIIN OF QUEENSBURY
BUILDING &,CODE ENFORCEMENT
742 Bay Road
Queensbery NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name itii _
Location \ M R � cD.c)
Date W --Z3-99 Permit # Ti
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: umber-
Size - t. xt�
Stone size - '.
PIPING: ize Type
Bldg. to Tank )
Tank to Dist.- Box - `
Dist. Box to Field/Pi
Openings Sealed? es No Partial
LOCATION/SEPARATIO1
Foundation to Tan •feet
Foundation to A. orption feet
Separation of °its feet
Conforms as ser Plot Plan Yes No
LOCATION_0 SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side — Right Side
Middle Front - Middle Rear
COMMENTS:
C c EQ__ Vrr5 t VA
1E _ Cyr M 5\
E OE—
SYSTEM USE APPROVE' 44,
NO
Arrive, .
Dep. ° ed Ira
oeK
/i ñh
ti din,
pec it
•
TOWIil OF QUEENSBURY
BUILDING & CODE ENFORCEMENT • . •
531 Bay Road . •
Queensbury NY 12804 . ,
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION •
Name 1 f�l�>
Location /3 - 4.0
Date % Permit # —
/f
� 9
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To al Length _
Length of -.ch trenc '�
Depth of tr- ches
Size of stone
SEEPAGE PITS: umb:r-
Size - 4 ft.
Stone size
PIPING: • S-ze . Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to-Field/"it
Openings Sealed? Yes No Partial
LOCATION/SEPARATION,:
Foundation to Tank feet
Foundation to Absor.tion 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:
/ ,/- /‘84-i •
SYSTEM USE APPROVED: YES NO
Arrived: c230
Departed:
•
Building Inspector •
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ofr
Location /6
Date 20 S Permit # </;(
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tota Leng h
Length of each trench
Depth of trench-s
Size of stone /gliFp-
SEEPAGE PITS: Num►er-
Size - ft x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. B•
Dist. Box to Fidld/Pit
Openings Sealed. Yes No Partial
LOCATION/SEPARA, IONS:
Foundation to T;:nk feet
Foundation to bsorption feet
Separation of 'its 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:
16 is
/ti sA// /vew 6Fx s RI
,21 of S L of../-X -/( ^dr
SYSTEM USE APPROVED: YES I�0
Arrived: 3130
Departed:
Ok-
Building Inspector
I i I. - r I - -
l I I I•
• ,
i ; 11 'rp; 1 cif or or /
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Ta
11 ::UIL.1Ne, AND CODE
�k , 0 6 6
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U 'RI VI:W n B 4:41:Ao1,..„_ ...zymk-4.�
D 'TE ...
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1
"I have seen or observed,or ber: saw evidence
all objects such as houses,wells,trees,fencese of,
shown on this document. I also represent that I have.
personally measured the distances set forth on the diagram."
/,'-ei/( -& 1-C--vi-171
SIGNATURE
DATE -