1999-363 Certificateof Compliance
Town of Queensbury `
Warren County,New York
•
Date June 24 99
99363
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be used as a SEPTIC ALTERATION •
22 EROADACRES RD.
Location
Owner MAC LEAN, ALEXANDER Sc
TAX MAP NO. 114 . -1 t)- By Order Town Board
TOWN_OF QUEENSBURY •
•
Director.of Building CodeEnforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 99363
TAX MAP NO. 114. -10-4 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to MAC LEAN, ALEXANDER &
OWNER of property located at 2 2 BROADACRES 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 -
BONNIE JO 22 BROADACRES RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or"BUILDER'S Name -
QUEENSBURY: SEWER,
3. CONTRACTOR or BUILDERS Address
4. ARCHITECTS 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
June 21 2001
$ 25 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.)
21 June 19 1999
Dated at the Town of Queensbury this Day of
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
ti
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
'99363 114: -10-4
Dept. of Community Devi MAC LEAN,: ALEXANDER &. : Permit No. j9 3 -45
Building &Codes Office 6
2 2 BROADACRES RD..' • j
742 Bay Road SEPTIC ALTERATION Fee Paid $
Queensbury, NY 12804
'72
Location of property for installation: I V 6 ""CI a.'�"Ins
Property Owner's Name: ! ! ,e y ,Q . d /14 GC C /
Property Owner's Mailing Address: °� �1''49.e12 d
Installer's Name: Ou,„0- Phone # —29 —
Number of bedrooms (if residential): ,S Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
• Soil Nature: X sand, loam, clay, other I depth:
• Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: )c not required, required [rate min. per inch]
Domestic water supply: >(" municipal, well, other
If domestic water supply is a WFT.T, water supply from any septic absorption is RFa-EiVED
PROPOSED SYSTEM JUN 2 1 1999
Septic tank:fry v gallon (minimum size: 1,000 anal.) TOWN O`'QUEENSBURY
BUILDING AND CODE
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of 2-- / size each.: . ft.by & ft.
Size of stone to be used: # / depth or thickness 2 feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: .• Size of each: gallons
Alarm system and associated electrical work to be inspected by a certified ages y.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or
approval grimed which is based upon or is granted in reliance upon any material misrepreseutztian or failure to make a
material fact or circumstance known by or on behalf of an applicant, cha11 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 San;tary Sewage Disposal • .
Signature of responsible person: LOB Date: 6.
\ 1
POW _--. . -.4
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name .0\/\(\,e0.,--- TN___PQR,V\
Location IN. _Ar A -1 la
Date 11 9 ?-, 3� Permit #
SOIL TYPE. Sand oam-Clay-
Results of Percolation Test-
(if applicable) 'Rate-Minute/Inch
TYPE OF SYSTEM: \
ABSORPTION FIELD: \Total Le gth
Length of each trench
Depth of trenches \
Size of stone \
SEEPAGE PM0 Number- 1
Size - 0 ft. x c '\ ft.
Stone size _ � \
PIPING: Te\\ Type. • .
Bldg. to Tank " '
Tank to Dist. Box • r 13`e2 3 '---
Dist. Box to Field/P ., 11 k\,
Openings Sealed? `, No Parti aT`�...
LOCATION/SEPARATION`.
Foundation to Tank 1/ feet
Foundation to Absorptisn I't feet
Separation of Pits ' __ feet
Conforms as per Plot P an 4110 No
LOCATION OF SYST U. "'OPERT .
(circle D
Front - 'ear - Left Si.' - Right Side
Middle Fron - dam- Rear
COMMENTS:
SYSTEM USE APPROVED: YES .NO
Arrived: 2
Departed:
Building Inspector -- - .
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"I have seen or observed,br believe I saw evidence of,
•
all obje s such as houses, wells,trees,fences, etc., oh h1e 4.A1e
n this document. I. I�so represent that I have NI AGE en
CS 4 'IR
personally measured the distances s forth on the diagram."
a0Mr. & Mrs. A.W.C. MacLean
22 Broadacres Road b�h ,
SIGNATURE DATQueenobury, N.Y. 12804