1999-421 CERTIFICATE OF COMPLIANCE
TOWN Or QUEENSBURY.
WARREN COUNTY, NEW YORK
Date - July 8 19 99
ol11 ' �
6 99421 v
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
70 JOHN .ST:.
Location
HARRINGTON., GUY, JR &
Owner
TAX MAP NO. 121 .-1- 16 .60 By Order of Town Board:
TOWN -OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT 1999
VALUE . .$ 0_. TOWN OF QUEENSBURY No.. 99471
TAX MAP NO. 121 . —1-16 . 60WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HARRINGTON, GUY, JR. &
OWNER of property located at 70 JOHN ST. 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
KINGSLEY, NANCY ANN 70 JOHN ST.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDERS Address
2 LOWER WARREN STREET
:QUEENSBURY, NY. 12804
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( 1 Masonry ( )Steel ( 1
7. PLANS and Specifications
SEPTIE. ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
July 8 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 Oueensbury before the expiration date.)
8 : Dayof July . . 19 1999
Dated at the Town of Queensbury this
SIGNED BY " r— for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No.
Building &Codes Office o D
742 Bay Road Fee Paid S " '-
Queensbury, NY 12804
4
Location of property for installation: 0 /
Property Owner's Name: #44 n o ,t,,iA 7 -
Property Owner's Mailing Address: ' lO - s 1i .c /
Installer's Name: � , 13, f, r. ✓ Phone # r /9G(
•
. Number of bedrooms (if residential): ) Total daily flow: i„ro
(residential -compute @ 150 gal./bdrm.)
Topography: t, rolling, steep slope % of slope
- Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth?I14feet / Bedrock or Impervious Material: at what depth? feet
Percolation test:IVA—not required, required j rate min. per inch]
Domestic water supply: )unicipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. .
PROPOSED SYSTEM
Septic tank/bOe gallon (minimum size: 1,000 I.)
Tile field: each trench (, feet / Total system length: /9 0 feet
Seepage pit(s): number of ^^�� / size each: . ft.by ft.
Size of stone to be used: # o'er / depth or thickness I feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: • Size of each.: gafons
Alarm system and associated zIectrical Rork to be inspected by a certified ageocr.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Qoeecsbury, any permit or
a�,F,�uval granted which is based upon or is granted in reliance upon any material nsisrepreaett pion or failure to make a
material fact or circumstance]mown by or on behalf of an applicant, ahatl be void. •
I have read the regulations with respect to this application and agree to abide by these and all regurements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: Date: ?••-
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road
Queensbury NY .12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name •
Location 76
Date 7jirC Permit # 95%/1/
SOIL TYPE: Sand-Loam-Clay-
Results of Percolat. n Test-
(if applicable) Ra Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length 070)
Length of each tr- ch ey43
Depth of trenches j ,273
Size of stone -- -SEEPAGE
-
SEEPAGE PITS: N ber-
Size - fr• x ft.
Stone size
PIPING: Size Type .
Bldg. to Tank //1/
Tank to Dist. Box gfr 5101g
Dist. Box to Field/Pit„y2___ SbA?
Openings Sealed? (!is ) No Partial
LOCATION/SEPARATIONS:
Foundation to Tank fp/s41 feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Qfs7 No
LOCATION OF SYSTEM ON PROPERTY:
(circle I.14;
Front - 'ea )- Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
4(1/ 2 ttAJ
SYSTEM USE APPROVED: YES p,
Arrived: /10.)
Departed:
Building Inspector
(41
TOIN. OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury HY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name n3..
Location -7 0
Date-7'Y'19 Permit # L° 04
SOIL TYPE: Sand- oam Clay-
Results of Perco ati n Test-
(if applicable) ate Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD otal Length d,ta
Length of each ench Vo
Depth of e �=)
Size of stone Z
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 4' 0
Tank to Dist. Box t/u S �
Dist. Box to Field f y" S[,df�
Openings Sealed? Yet/' No Parti al
LOCATION/SEPARATIONS:
Foundation to Tank // feet
Foundation to Absorption i) feet
Separation of Pits
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERT .
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
•
SYSTEM USE APPROVED: CIO NO
Arrived: ✓f 10
Departed:
Building Inspector
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iBUILDING - '
"I have seen or observed, or believe"I saw evidence of;-.. -__. .------- - -- -- - '-- - -- , H ',
all objects such as houses, wells, trees,fences,etc., J S r
shown on this document. I also represent that I have
CI . � )' /a) 1v N)(
personal) Measured the dist n �� a (.0 . ;• ., , ' ' '
ces set forth on the diagram." , . I j
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