1999-381 •
Certificate � Compliance f
Town of Queensbury
Warren County,New York
June 24 9 9
Date,_„_
•
95381
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 •
73 COUNTRY CLUB RD.
Location
Owner BROWN, MAYNARD R. J R.
TAX MAP NO. 61 . --1-2
By Order Town Board
TO QUEENSBUzY •
Director.of Building Code'Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE- .$.••0. . • No. 99381
TAX MAP NO. 61 . -1-2 • WARREN COUNTY, NEW YORK •
PERMISSION is hereby granted to.. ' • BROWN, MAYNARD R. , JR.
•
OWNER of property located at 73 COUNTRY CLUB 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
' 73 COUNTRY CLUB RD.
QUEENSBURY, NY 1.2804...
2. CONTRACTOR or BUILDER'S Name.
SANITARY SEWER
3. CONTRACTOR or.BUILDERS Address
DAN .DRELLOS - .PO BOX: 224 .
GLENS..FALLS NY-- .. 12.801
4. ARCHITECT'S Name .
5. ARCHITECT'S Address
•
6. TYPE of Construction—(Please indicate by X)
. SEPTIC.
( 1 Wood Frame ( )Masonry ( )Steel 1 )
7. PLANS and Specifications . .
SEP:TIL'a•..ALTERATION-AS-.PER PLOT PLAN :SPECIFICATIONS
8. Proposed Use . . . . . .
SEPTIC ALTERATION
$ 25 - PERMIT FEE PAID—THIS PERMIT `EXPIRES June. 24: 19 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 Queensbury before the expiration date.)
Dated at the Town of Queensbury this 2 4 Day of June< 19 1999
SIGNED BY for the Town of Queensbury
. Building and Zoning Inspector .
• 1
'• fly;,.- • Application for SEPTIC DISPOSAL PERMIT
. ( •
Town of Queensbury
Permit No.C.- (4--3131
Dept. of Community Development
&Codes Office
• 742 Bay Road Fee Paid 0--S C?
Queensbury, NY 12804
•
Location of property for installation: 73 au cu_,L 7z-DRF--
'CFNED
Property Owner's Name: MALlikiift 9 B roGiA)
tstiNF ' ENS
July 2 3 7999
• Property Own 'a Mailing Address: 7,1 Ain, CAA, 6TooliDo
A coDE
• Installer's Name: CiAio ijw Phone # 9-27----/-27
--Number of-bedrooms (if residential): Total daily flow: 3• 33
(residential -compute @ 150 gal./bdrm.)
Topography: flat, _rolling, _ steep slope % of slope
• Soil Nature: IL sand, loam, clay, other /depth:
•
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test not required, required [rate rain. per inch]
Domestic water supply: municipal, well, icher
• If domestic water supply is a WELL, water supply from any septic absorption is . feet.
PROPOSED SYSTEM
•
Septic tank )00. gallon (rninirnitm size: 1,000 gal.)
Tile field: each trench 51) feet / Total system len.srth: /6—°. feet
•
Seepage pit(s): number of (4)/4- / size each: ft. by ft. •
Size of stone to be used: # 2-- / depth or thickness / feet •
•
•
•
HOLDING TANK SYSTEM:. (if required)
Number of tanks: Size of each: gallons
. .
•
(Alarm sistern aid associated electrical work to be inspected by a certified agency.) •
,14,1AForlo_Foprotection, please note that pursuant to Section 136-29 of the Code of the Town of Query, any permit or
1.e,,;4pi*imam!which is based icon or is graded in reliance upon any matesid misrepresentation or failure to make a
material fact or dicamstance Inxtiwn by or on behalf of an applicant;shall be void.
-I have read the regulations With to application and to • these and all requirements Of the Town of
Queensbury Sanitary Sewage • ' .
•
Signature of resi:onsible perso Date: (,
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
J Permit # "`VVV
Date 'r;�' '- 9� —3g/
SOIL TYPE San&Loam-Clay-
Results of Percolation Test-
(if applicable) Ra e-Minute/Inch
TYPE OF SY TEM:
ABSORPTION FIELD: T tal Lengtf� �� )
Length of e ch trench / �7)
Depth of trenches
Size of stop- 'zy
SEEPAGE PITS: Number
Size - ft. x ft.
Stone size
Bldg.PIPNG: ze ;ypeA
b
to Tank �
Tank to Dist. Box
Dist. Box to Field/P . ,g cq
Openings Sealed? iggy No Partial
LOCATION/SEPARATION`.
Foundation to Tank �� S feet
Foundation to Absorpti .n d feet
Separation of Pits eet
Conforms as per Plot P an No
LOCATION OF SYSTEM ON i`'ROPERT :
(circle one) 1
Front - Rear - Left Spde - Ri ht Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: 4010 NO
Arrived:
Departed:
j 12,
Building Inspector
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"I have seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences, etc.,
Comer GC,v �t-ooa� shown on this document. I also represent that I have
`'"1 personally measured the distances set forth on the diagran
SIGNATURE — DATE
.y
1