1999-299 Tow-
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. 99299 Date Issued: Wednesday, June 02, 1999
This is to certify that work requested to be done as shown by Permit Number 99299
has been completed.
Tax Map Number. 523400-295-014-0002-060-000-0000
Location: 5 JOHN CLENDON Rd
Owner. JONATHAN & BERNADETTE MICHAEL
Applicant: MICHAEL, JONATHAN &
This structure may be occupied as a:
Unknown
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the44,
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 99299
TAX MAP NO. 82 . —6-44 WARREN COUNTY, NEW YORK.
PERMISSION is hereby granted to MICHAEL, JONATHAN &
OWNER of property located at 5 JOHN CLENDON 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.
BERNADETTE 5 JOHN CLENDON RD.
QUEENSBURY, NY . 12804 .
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
JAY SWEET .
0 .
4. ARCHITECTS Name .
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
No.
8. Proposed Use
SEPTIC ALTERATION
25
$ PERMIT FEE PAID —THIS PERMIT EXPIRES May 28 2001
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.)
28 May 19 1999
Dated at the Town of Queensbury this - Day of _
SIGNED BY for the Town of Queensbury
Building and Z ning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury !ill C E-I V D Permit No. to_alai
'Dept. of Community Development
Building &Codes Office
742 Bay Road MAY 2 8 1999 Fee Paid S o25. c`'
Queensbury, ICY 12804 TOWN OF QUEENSBURV
BUIG Ale! OD h i
Location of property for installation: �3LDJDJ o CJ f P j1 Jo Li ts--i,
Property Owner's Name: -` -
P ny �� ft /l� I V\ l L� lc �
Property Owner's Mailing Address: cCii-vt -ems
.
Installer's Name: 6),(_e.p_,1/S T3e_e. .(,),A(.- Phone # If a2 6
Number of bedrooms (if residential): _ Total daily flow: 43-73
(residential - compute @ 150 gal./bdrm.)
Topography: X flat, rolling, steep slope % of slope
• Soil Nature: _sand, loam, clay, other I depth:
•
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test:, not required, required [rue min. per inch]
Domestic watersupply: �
municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. •
PROPOSED SYSTEM tanlct-ar / gallon
Psi-
Septic
(minimum� ( um size: 1,000 sal.)
Tile field: each trench L feet / Total system Iength: ...24rd feet
Seepage pit(s):•number of / size each: . ft.by ft.
Size of stone to be used: # 7i / depth or thiclmess /2/p feet •
HOLDING TANK SYSTEM: (if required)
Number of tanks: ••• Size of each: gallons
r
Alarm system and associated electrical work to be inspected by a certified agaser.
J
' For yotn protection, please mote that pursuant to Section 136-29 of the Code of the Town of Qaee.siaay, any permit or
aidim.uval granted which is based upon or is granted in reliance upon a:--y material misrepresentation or failure to make a
material fact or circumstance kmwn by or on behAlf of an applicant, email be void.
I have read the regulations with respect to this application and a.ree to abide by these and all recpS-ements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: Dater
d l
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name do Ho R lc.v4R00
Location 4 e,�-� CLLF-A\ � .D
Date 6 -cm ' -rmit # 99 =Z99.
SOIL TYPE• Sand-!.= Cl\ay-
• Results of Perco ation Tiiest-
(if applicable) "ate-Mi►iute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: TOdf Length 'Z.Og
Length of 'e.ch t ch F.4� b,
Depth of trenches 7 .
Size of stone Z
SEEPAGE PITS: Nu ber-
Size - ft. x ft.
Stone size
PIPING: Size Type LIsr
Bldg. to Tank 1-1"vC-t4, 1-40- .0...P...
- -Tank to_[).i st._Box- - -- - __ 1- `!- '_� 5
Dist. Box to Field/P' ' " ____
Openings Sealed? dilliiiirt4 Partial
LOCATION/SEPARATIONS:
Foundation to Tank k feet
Foundation to Absorption _Feet
Separation of Pits feet
Conforms as per Plot P1 an iiilOW o
LOCATION OF SYSTEM ON PROPE''' .
(circle "
Front 7 - Left. Side rrtrait_Side—
Midge Front - Middle Rea
COMMENTS:
•
SYSTEM USE 'APPROVED: (-7];E1 O
• Arrive, . =�;� /
:,
11)
Depa' ed• ,Obli i
,� r�/f
dui di . -pector -
FIRE MARSHAL
TOWN OF QUEENSBURY
'f , • QUEENSBURY, NY 12804
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED S 3 PERMIT# �_]
NAME /Y/ at Z L 1 v\ 1
LOCATION a '• ` .f) • 61i
SCHEDULE INSPECTION ON 9
/ AM6 ANYTIME
(C.429e/-C1 f 6- APPROVED
N/A YES NO
EXITS
AISLE WIDTHS /"
EXIT SIGNS /
EMERGENCY LIGHTING
FIRE EXTINGUISHERS /
FIRE ALARM SYSTEM
FIRE SPRINKLER SYS EM
FIRE SUPPRESSION S STEM
HOOD INSTALLATION -'
INTERIOR .KNISHES ___
STORAGE: ���;
CLEARANCE--OIISPRINKLERS
CLEARANCE TO]HEATING UNITS
REQUIRED SIGNAGE I
CHIMNEY I
!
WOOD STOVE
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT
REMARKS: ❑ OK TO THIS DATE
4 G a/-A e1/74 Y) -<- 6 f<--d4D
/4e7,- ef1- 71 4z--- z0....i
---&t
INSPSLIP.PUB INSPECTOR
V1f S•
"I have seen or observed,or believe saw evidence of, u�L>� ��
all objects such as houses,wells,trees,fences„etc., I ''
shown on this document. I also represent that I have DEVIE D BY
p onally measured the distances orth on the diagram"
`DATE `
oP . .. . ,;-6'1,f ,
/ SIGNATURE DATE
:TOWN0
QUEENvgi s<DUG DEPARTMENT
S'red on our limited examination,
�� Co. pliancy w ith our comments shall
..e.--, ..›Z____ ----' no oe construed as indicating the
�� —� o `� pia s and specifications are in full
co pliancy with the code.
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C6cf-0--tg— i-0 MAY 2 $ 1999
TOWN OF QUEENSBURY
BUILDING AND CODE
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